摘要
目的比较右胸微创小切口二尖瓣置换术与传统二尖瓣置换术的临床疗效和安全性。方法回顾性分析2009年2月至2011年12月武汉亚洲心脏病医院68例心脏瓣膜病患者(微创小切口组)的临床资料,其中男36例,女32例;年龄(34.2±11.2)岁;二尖瓣狭窄21例,二尖瓣关闭不全17例,二尖瓣狭窄伴二尖瓣关闭不全30例;合并三尖瓣反流19例;均行右胸微创小切口二尖瓣置换术。同期收治200例心脏瓣膜病患者(对照组),其中男86例,女114例;年龄(49.4±13.2)岁;二尖瓣狭窄85例,二尖瓣关闭不全66例,二尖瓣狭窄伴二尖瓣关闭不全49例;合并三尖瓣反流76例;均行传统二尖瓣置换术。比较两组患者的院内死亡率,主动脉阻断时间、住ICU时间、术后胸腔引流量、二次开胸止血和术后并发症发生率。结果微创小切口组患者无院内死亡,两组院内死亡率、体外循环时间、二次开胸止血率、术后心律失常发生率、肾功能衰竭需要透析和伤口感染发生率比较差异均无统计学意义(P>0.05)。微创小切口组主动脉阻断时间长于对照组,而术后机械通气时间[(10.2±3.1)h vs.(15.2±7.1)h,P=0.008]、术后胸腔引流量[(92.0±28.0)ml vs(.205.0±78.0)ml,P=0.000]、术后输血量[(0.8±1.6)U vs(.1.9±2.1)U,P=0.006]、住ICU时间[(14.0±8.0)h vs(.26.0±12.0)h,P=0.003)和住院时间[(14.8±4.6)d vs(.19.7±3.2)d,P=0.006]均短于或少于对照组。结论右胸微创小切口二尖瓣置换术在手术安全性上与传统二尖瓣置换术相当,并不增加术后并发症的发生;此外右胸微创小切口二尖瓣置换术在术后恢复上显著优于传统二尖瓣置换术。
Objective To compare clinical outcomes and safety between minimally invasive mitral valve replace- ment via right minithoracotomy （mini-MVR） and traditional mitral valve replacement （MVR）. Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively, there were 21 patients with mitral stenosis （MS）, 17 patients with mitral insufficiency （MI）, 30 patients with MS and MI, and 19 patients with tricuspid insufficiency （TI）. Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4± 13.2 years. Preoperatively, there were 85 patients with MS, 66 patients with MI, 49 patients with MS and MI, and 76 patients with TI. Hospital mortal- ity, aortic crosselamp time, length of intensive care unit （ICU） stay, postoperative chest tube drainage, reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality, cardiopulmonary bypass time, incidence of reexploration for bleeding, postoperative arrhythmias, dialysis-requiring acute renal failure and wound infection be- tween the two group （P 〉 0.05 ）. Aortic erossclamp time of the mini-MVR group was significantly longer than that of the eontrol group. But postoperative mechanical ventilation time （ 10.2±3.1 h vs. 15.2±7.1 h, P=0.008）, chest tube drainage （92.0±28.0 ml vs. 205.0±78.0 ml, P=-0.000）, blood transfusion （0.8±1.6 U vs. 1.9±2.1 U, P=0.006）, length of ICUstay （ 14.0± 8.0 h vs. 26.0± 12.0 h, P=0.003 ） and length of hospital stay （ 14.8 ±4.6 d vs. 19.7 ± 3.2 d, P=0.006） of the mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety ofmini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities, while the postoperative recovery after mini-MVR is better than traditional MVR.
出处
《中国胸心血管外科临床杂志》
CAS
2013年第2期139-143,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
