【摘要】 目的 总结右胸前外侧小切口二尖瓣置换手术临床经验,探讨其临床意义。方法 对2011年4月至2014年8月期间行右胸前外侧小切口二尖辨置换术(微创组)60例患者临床资料进行分析。其手术径路为经右胸前外侧第4肋间切口,采用股动脉、股静脉建立体外循环,经房间沟或右房切口实施二尖瓣置换手术,术后评估手术效果。并与行常规胸骨正中切口二尖瓣置换手术80例患者(对照组)进行比较。结果 60例均手术成功,术后早期死亡1例,死于低心排血量综合征和右心功能不全。胸骨正中切口组无死亡病例。微创组平均手术时间(198.5±58.2)min,体外循环时间(49.5±18.2)min,升主动脉阻断时间(43.0±18.6)min,术后平均呼吸机辅助时间(7.2±3.0)h,术后平均胸腔引流液(415.5±252.4)ml,平均住院时间(12.5±4.4)d。微创手术组患者与胸骨正中切口组患者比较,微创组手术时间长于传统手术组,体外循环时间、升主动脉阻断时间差异无统计学意义(P>0.05),术后呼吸机辅助呼吸时间,术后胸腔引流液及术后住院天数微创组少于传统手术组。结论 右胸前外侧切口二尖瓣替换术安全可靠。与传统正中切口比较,减小生理、心理创伤,有利于患者术后的恢复,值得推广应用。更多还原

【Abstract】 objective To review and summarize the successful experience of 60 patients with minimally invasive mitral valve surgery via right minithoracotomy.Methods From April 2011 to August 2014,60 patients with mitral diseases were enrolled and underwent mitral valve replacement through right minihtoractomy.Surgical access was through a right anterolateral thoracotomy in the forth intercostal space.A main surgical incision was made over the lateral border of the right breast.Cardiopulmonary bypass was established via femoral cannulation.Mitral valve replacement were performed via interatrial groove or right atrium.80 cases with mitral diseases through traditional medium sternotomy were also enrolled.Result All the operations were successful.One patient died postoperatively,which died of low cardiac output syndrome and right heart insufficiency.No dead patient was found in the traditional surgery group.Mean operation,cardiopulmonary bypass and aortic clamp times were(198.5 ± 58.2) min,(49.5 ± 18.2)min and(43.0 ± 18.6) min respectively.The mean postoperative ventilation time was(7.2 ±3.0) h.The mean total chest tube drainage was(415.5 ± 252.4) mL,and the mean length of hospital stay were(12.5 ± 4.4) d..No differences were found in the cardiopulmonary bypass and aortic clamp times between the minimally invasive operation group and the traditional one.Although the mean operation time in invasive group was longer than the traditional group,but its mean ventilation time and the mean length stay of hospital were shorter,and its mean total chest tube drainage was less than that one.Conclusion Minimally invasive mitral valve surgery via right minithoracotomy is feasible,safe.It has less trauma and injury for patients,and benefits patients’ rapid recovery.Minimally invasive mitral replacement is worthy of widely clinical elective application.更多还原