【摘要】 目的探讨右胸小切口胸腔镜辅助二尖瓣置换的疗效。方法 2012年9月~2014年8月施行胸腔镜右胸小切口微创二尖瓣置换术44例,采用穿刺股动脉、股静脉插管建立外周体外循环,负压辅助静脉引流,Chitwood钳经胸阻闭升主动脉,冷血心脏停跳液顺行灌注保护心肌,CO2充满术野减少空气栓塞发生,胸腔镜辅助下完成二尖瓣置换术。结果无死亡,2例胸腔严重粘连中转开胸行瓣膜置换术,1例发生股静脉损伤术中修补。体外循环时间82~284 min,(150.1±37.4)min;升主动脉阻断时间52~161 min,(89.6±26.3)min;术后呼吸机辅助时间8~47 min,(18.3±7.7)h;ICU时间24~92 h,(44.7±16.9)h;术后胸液引流量125~1085 ml,(363.9±193.3)ml;输血量100~1600 ml,(697.1±486.0)ml。43例随访1~23个月,平均13.0月,心悸、胸闷症状均较术前缓解。结论右胸小切口胸腔镜辅助二尖瓣置换安全,疗效满意。更多还原

【Abstract】 Objective To evaluate the efficacy of minimally invasive mitral valve replacement through right mini-thoracotomy under video-assisted thoracoscopy. Methods Forty-four patients underwent minimally invasive mitral valve replacement through right mini-thoracotomy under video-assisted thoracoscopy from September 2012 to August 2014. Cardiopulmonary bypass was achieved peripherally with vacuum-assisted venous drainage. A 4- 6 cm incision was made in the right chest. Transthoracic aortic cross-clamp( Chitwood clamp) was conducted. Cardioplegia perfusion was carried out for myocardial protection,with CO2 perfusion for preventing aeroembolism. And mitral replacement was performed under thoracoscopy. Results The cardiopulmonary bypass and aortic cross clamp time were 82- 284 min( mean,150. 1 ± 37. 4 min) and 52- 161 min( mean,89. 6 ± 26. 3 min),respectively. The postoperative mechanical ventilation time was 8- 47 h( mean,18. 3 ± 7. 7 h). The length of stay in the intensive care unit was 24-92 h( mean,44. 7 ± 16. 9 h). The chest drainage volume was 125- 1085 ml( mean,363. 9 ± 193. 3 ml). The blood transfusion was100- 1600 ml( mean,697. 1 ± 486. 0 ml). Follow-up examinations for 1- 23 months( mean,13. 0 months) in 43 cases showed markedly remission of symptoms such as palpitation and chest tightness. Conclusion Right thoracoscopic minimally invasive mitral valve replacement is safe and effective.更多还原