微创右胸切口与常规胸骨正中切口二尖瓣手术同期修复三尖瓣病变的病例对照研究

Right Minithoracotomy versus Conventional Median Sternotomy for Patients Undergoing Mitral Valve Surgery Combined with Tricuspid Valve Surgery:A Case Control Study

目的比较微创右胸切口与常规胸骨正中切口施行二尖瓣手术时同期修复三尖瓣的安全性及其疗效。方法回顾性分析2006年6月至2013年6月新华医院行二尖瓣手术同期修复三尖瓣病变475例的临床资料。按手术方式将患者分为两组:微创手术组,116例,行微创右胸切口;常规手术组,359例,行常规胸骨正中切口。其中男178例、女297例,年龄38~73岁。结果术中经食管超声动心动图(TEE)结果提示,二尖瓣无反流426例,轻度反流49例;三尖瓣无反流282例,轻度反流193例。出院前经胸超声心动图(TTE)提示,二尖瓣无反流429例,轻度反流38例,轻中度反流5例;三尖瓣无反流315例,轻度反流150例,轻中度反流7例,均无瓣周漏或瓣膜狭窄,两组均无明显差异。结论对于二、三尖瓣联合瓣膜病变,微创手术可达到与常规手术相同的治疗效果,且具有良好的美容效果。

Objective To compare the outcomes of concomitant mitral valve surgery and tricuspid valve surgery through right minithoracotomy and conventional median sternotomy approaches.Methods We retrospectively analyzed clinical data of 475 patients underwent mitral valve surgery combined with tricuspid valve surgery through right minithoracotomy or conventional median sternotomy in Xinhua Hospital between June 2006 and June 2013.The patients were divided into two groups including a minimally invasive group(116 patients) and a conventional group(359 patients).Results All the patients successfully underwent mitral valve and tricuspid valve surgery.During operation,there were 426 patients with no trivial mitral regurgitation(MR) and 49 patients with trivial MR.There were 282 patients with no tricuspid regurgitation(TR) and 193 patients with trivil TR.At discharge,transesophageal echocardiography showed that trivial MR in 38 patients,mild MR in 5 patients,trivial tricuspid regurgitation(TR) in 150 patients and mild TR in 7 patients.There was no significant difference between the two groups in complications.Conclusion Right minithoracotomy can achieve the similar therapeutic effect to conventional median sternotomy for patients with mitral valve disease and concomitant tricuspid valve disease.In addition,patients through right minithoracotomy had better cosmetic outcomes.