经右胸小切口二尖瓣置换术

MITRAL VALVE REPLACEMENT WITH MINIMUM INVASIVE INCISION THROUGH RIGHT THORACOTOMY

目的 探讨经右胸小切口二尖瓣置换术径路的可行性。方法 采用右腋中线至乳头线的弧形切口 ,长 10～ 12cm ,经第 4肋间进胸。常规建立体外循环 ,降温并阻断循环 ,30例单纯二尖瓣病变者经右心房间沟入路 ,6例合并三尖瓣病变者经右心房—房间隔入路 ;全部采用连续缝合固定机械瓣。结果 全组无死亡 ,无感染及瓣周漏 ,转机 6 5～ 10 5min ,心肌阻断 4 5～ 80min ,住院 10～14d痊愈出院。结论 右胸外侧小切口行二尖瓣置换术创伤小、出血少、恢复快 ,切口隐蔽美观 ,病人乐于接受。

Objective To report 36 cases having undergone mitral valve replacement with minimum invasive incision through right thoracotomy and to investigate the feasibility of this operative approach.Methods A 10～12cm long arc-shape incision were made through 4th intercostal space between middle axillary line and papilla line.Cardiopulmonary bypass was instituted with conventional methods.Interatrial sulcus approach was used in 30 cases with simple mitral valve disease.In 6 cases with mitral valve disease combined with tricuspid valve disease,right atrium and atrial septal incision was made.The prosthetic valves were secured with continuous running suture in all cases.Results There were no mortality and morbidity including infection and peri-valvular leak.The total CPB time was 65～105 minutes and aortic cross-clamping time was 45～80 minutes.The hospitalization time was 10～14 days.Conclusion Mitral valve replacement with minimum invasive incision through right thoracotomy results in limited damage,decreased blood loss and fast rehabilitation.The patient is willing to accept this kind of hidden incision with cosmetic effect.