影响胸骨小切口瓣膜替换术因素的探讨

The related factors affecting valvular replacement through ministernotomy

目的 探讨胸骨正中中下段小切口（胸骨小切口）瓣膜替换术中影响术野显露及手术操作的因素。方法３５例接受胸骨小切口瓣膜替换手术，包括２３例二尖瓣替换（ＭＶＲ）和１２例二尖瓣和主动脉瓣双瓣替换（ＢＶＲ），其中男１９例，女１６例，年龄为２１～６２（４４ ± ９）岁，分析患者胸廓和心脏形态特征对主动脉阻断时间（ＡＣＴ）和体外循环时间（ＣＰＢＴ）的影响。结果 左室舒张末内径在６０ｍｍ以上时，ＭＶＲ的主动脉阻断时间（ＡＣＴ）（ｐ＝ ０．００９）和体外循环时间（ＣＰＢＴ）（Ｐ＜０．００３）明显延长，但 ＢＶＲ的ＡＣＴ（ｐ＝０．０２３）和 ＣＰＢＴ（Ｐ＝０．０２２）明显缩短。胸骨柄上缘平第五胸椎以下时，ＭＶＲ和 ＢＶＲ的 ＡＣＴ和ＣＰＢＴ均罗平第四胸椎以上者延长，但差异不显著。主动脉结的高低、心胸比值、左房内径和主动脉窦内径对ＡＣＴ和ＣＰＢＴ均无影响。结论 左心室扩大及胸骨柄位置较低可能影响胸骨小切口瓣膜替换术的术野显露及手术操作。

Objective To determine the factors affecting valve replacement through mini - sternotomy. Methods 35 patients underwent mitral valvular replacement (MVR, 23 cases) or bivalvular replacement (BVR, 12 cases) through minimal sternotomy. 19 cases were male and l6 cases were female. The age ranged from 21 to 62 years with an average(44 ± 9) years. The factors affecting the aorta clamped time (ACT) and the cardiopulmonary by- pass time (CPBT) ware analyzed. Results When the left ventricular diastolic diameter was more than 60mm, ACT and CPBT were longer in MVR and were shorter in BVR. ACT and CPBT were almost significantly longer in MVR and AVR when superior margin of manubrium was lower than the fifth thoracic vertebra. Height of aortic node, cardiotho- racic ratio, diameter of left artia and aortic root were not related with ACT and CPBT. Conclusion Larger left ventricular and lower manubrium may be the related factors that affecting the operation of valvular replacement.