摘要
目的探讨保护患者心功能、减少患者手术创伤及手术并发症的三尖瓣手术方法。方法 2013年1月至2014年12月在广东省人民医院心外科接受手术治疗的255例三尖瓣关闭不全患者。根据三尖瓣病变类型分为房间隔缺损合并三尖瓣关闭不全167例,二尖瓣病变合并三尖瓣关闭不全73例,单纯三尖瓣关闭不全4例,其他疾病合并单纯三尖瓣关闭不全4例;根据三尖瓣病变程度分为三尖瓣重度关闭不全85例,中度关闭不全83例,轻度关闭不全87例。所有病例中含再次三尖瓣手术7例。采用的手术方法:三尖瓣De Vega瓣环成形术16例,三尖瓣Kays瓣环成形术40例,三尖瓣人工瓣环成形术174例,3例采用人工腱索,4例采用"缘对缘"技术,三尖瓣置换术18例。同期进行房颤射频消融术5例。术前、术后均使用食道超声评估三尖瓣形态,综合评估成形效果。结果 255例患者均未出现术中转正中胸骨切口及围手术期死亡,无心包填塞、感染等严重并发症,其中再次开胸止血5例。手术时间(185.3±58.6)min,体外循环时间(116.7±44.1)min,主动脉阻断时间(93.7±61.4)min,气管插管时间(12.6±3.6)小时,胸腔引流液(237.3±308.9)ml,术后住院时间(5.3±2.6)天。住院期间未使用血制品率81.0%。术后5天至3月复查心脏超声结果:重度返流2例(0.8%),中度返流3例(1.2%),轻度返流130例(52.4%)。结论完全胸腔镜技术应用于三尖瓣成形是可行的,对于瓣膜及其附属结构的暴露好,经过改良的成形方法可以运用于复杂的三尖瓣成形手术。该术式对于减低围术期死亡风险、减轻患者痛苦、减少ICU停留时间、缩短住院时间、降低总住院费用以及更好的血液保护预期有积极意义。中度以上的三尖瓣关闭不全,在完全胸腔镜下行人工瓣环成形术可作为优先考虑的外科手术方法。
Objective To explore the tricuspidvalve surgical methods that protect the heart function and reduce the surgical trauma and surgical complications. Methods From January 2013 to December 2014,255 patients with tricuspid valve pathological changes received the complete video-assisted surgical treatment in our department. According to lesion types, there were 167 patients with atrial septal defect combined with tricuspid valve insufficiency,73 with tricuspid valve insufficiency accompanying with mitral valve pathological changes,4 with simple tricuspid valve insufficiency, and 4 with tricuspid valve insufficiency accompanying with other lesions. According to lesion degree, there were 85 cases with severe tricuspid valve insufficiency,83 with moderate insufficiency and 87 with light insufficiency. In addition,7 cases had re-operations. Of these patients, 16 cases were treated with De Vega tricuspid valve re- pair,40 with Kays tricuspid valve repair, 170 with tricuspid valve repair with prosthetic ring,3 with artificial chordae technique,4 with ＂edge-to-edge＂ technique, and 18 with tricuspid valve replacement. Besides,5 cases received intra-operative radiofrequency ablation for atrial fibrillation. All cases were preoperatively and postoperatively evaluated by trans-esophageal echocardiography. Results There were no emergency situation to do median sternotomy or intraoperative death, pericardial tamponade,infection, and other serious postoperative complications. However,5 cases received re-thoratomy for hemostasis. The operation time was （ 185.3 ± 58. 6） min. The cardiopulmonary bypass time was （ 116. 7 ± 44. 1 ） rain. The aortic clamping time was （93.7 ± 61.4） min. The tracheal intubation time was （ 12. 6 ± 3.6） hours. The 1 st day volume of thoracic drainage after operation was （237.3 ± 308.9） ml. The postoperative days of hospital stay were （5.3 ± 2. 6） days. The rate of non-using blood products during hospital period was 81%. The results of TEE after 5 day and 3 months of operation showed that there were 2 cases with severe tricuspid valve insufficiency （0. 8% ） ,3 with moderate tricuspid valve insufficiency （ 1.2% ） ,and 130 with light tricuspid valve insufficiency （52. 4% ）. Conclusion The complete video-assisted surgical approach for treating the tricuspid valve insufficiency is feasible under the suitable technological conditions. It can guarantee a favorable operation view that makes more complex surgical procedures possible. The method can reduce the perioperative mortality and the time in ICU and hospital. It also brings less operative wound and decreases hospitalization expenses. Therefore,the surgical method is very suitable for severe and moderate tricuspid valve insufficiency.
出处
《实用医院临床杂志》
2016年第1期7-10,共4页
Practical Journal of Clinical Medicine
关键词
全胸腔镜心脏手术
三尖瓣
临床经验
Complete video-assisted cardiac surgery
Tricuspid valve
Clinical experience
