摘要
目的回顾分析39例单纯主动脉瓣换瓣手术患者，对比研究微创主动脉瓣替换术与传统开胸主动脉瓣替换术患者手术效果的差异。方法2010年6月至2012年1月，安贞医院心外科共完成单纯主动脉瓣替换术39例，其中微创主动脉瓣替换术24例（微创组），传统开胸主动脉瓣替换术15例（开胸组）。统计两组患者的性别、年龄、术前心功能、瓣膜型号、瓣膜类别、体外循环时间、主动脉阻断时间、手术时间、气管插管时间、是否自动复跳、是否输血、输血量、术后第1天引流量、术后第2天引流量、术前术后左室射血分数、围手术期并发症、切口长度、术后住院时间、总住院费用等数据并分析。结果两组患者均无围手术期死亡，无二次开胸止血。术后复查超声均无瓣周漏，无瓣膜功能障碍。尽管两组体外循环时间和主动脉阻断时间差异有统计学意义，但两组手术时间、心脏自动复跳率差异均无统计学意义（均P〉0．05）。微创组输血率低于开胸组（9／24比12／15，P=0．028）、切口长度（cm）小于开胸组（4．9±0．7比28．5±4．7，P=0．000）。术后引流、重症监护病房时间、气管插管时间、术后住院时间、住院费用差异均无统计学意义（均P〉0．05）。结论微创主动脉瓣替换术是安全的，相比常规开胸主动脉瓣替换术患者，微创组患者输血率少，手术切口小，美容效果显著。
Objective To compare the perioperative outcomes of minimally invasive versus conventional aortic valve replacement. Methods Between June 2010 and January 2012, 39 patients underwent isolated aortic valve replacement （minimally invasive： n = 24, conventional： n = 15 ） at our department. Gender, age, New York Heart Association class, valvular size, valvular type, cardiopulmonary bypass duration, aortic cross-clamping duration, total operative duration （skin incision to skin suture）, ventilation time, intensive care unit stay, blood loss volume, blood transfusion volume, left ventricle ejection fraction, perioperative complications, length of incision, hospital stay and hospital costs were used. Results There was no case of death or reoperation for bleeding. No statistically significant differences existed between both groups with respect to pefioperative course （ both P 〉 0. 05 ）. Only cardiopulmonary bypass duration and aortic cross-clamping duration were significantly longer in the minimally invasive group while blood transfusion rate （9/24 vs 12/15, P = 0. 028 ） and length of incision （ （4. 9 ± 0. 7 ） cm vs （ 28.5± 4. 7 ） era, P = 0. 000） were significantly lower in the minimally invasive group. Conclusion As a safe and reproducible procedure, minimally invasive aortic operation may require a smaller incision and achieve better cosmetic outcomes with a lesser volume of blood transfusion.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第40期2859-2861,共3页
National Medical Journal of China
基金
北京市科委首都临床特色应用研究面上项目（Z111107058811088）
关键词
外科手术
微创性
心脏瓣膜疾病
主动脉瓣替换术
Surgical procedures, minimally invasive
Heart valve diseases
Aortic valve replacement
