摘要
目的总结心脏再次手术行瓣膜置换的方法。方法心脏再次手术行瓣膜置换患者184例,173例患者采用正中开胸,11例采用右前外切口。经升主动脉和上下腔建立体外循环141例,经股动静脉插管建立体外循环33例。结果术后死亡12例,Logistic回归分析显示,术前心功能、合并手术是术后院内死亡的危险因素。结论心脏二次手术的难点是心脏术后心包粘连所致的解剖关系不清、手术时间长及心功能差,充分的术前评估、心功能调整及选择合适的体外循环方法可提高手术成功率,降低围手术期死亡率。
Objective To investigate methods of reoperation for valve replacement.Methods The medical records of 184 cases of reoperation for valve replacement were reviewed and analyzed.Results A total of 173 cases were operated by mid-thoracic incision and 11 cases were operated by right thoracic incision.Extracorpreal circulations were established by the ascending aorta and superior and inferior vena cave in 141 cases,and the others were established by the femoral artery and vein.In-hospital death oc-curred in 12 patients（6.52%）.Cardiac function and combined operations were the risk factors for in-hos-pital mortality.Conclusion Anatomic confusion resulted from cardiac adhesion,poor cardiac function, and long extracorpreal circulation time was the difficulty for reoperation.Comprehensive preoperative eval-uation,sufficient heart function adjustment and appropriate extracorporeal circulation can improve the suc-cess rate of operation,and reduce perioperative mortality.
出处
《临床外科杂志》
2017年第1期49-50,共2页
Journal of Clinical Surgery
关键词
瓣膜置换
再次手术
valve replacement
re-operation
