摘要
目的比较不同微创小切口在主动脉瓣置换术中的应用效果。方法回顾性分析187例行主动脉瓣置换术患者的临床资料,根据手术入路不同,分为胸骨全切开组(FS组,50例)、胸骨上段小切口组(PUS组,50例)、右侧胸骨旁纵行小切口组(RPLI组,39例)、右侧胸骨旁横行小切口组(RPTI组,48例)。记录并比较四组人工瓣膜置换的类型及型号、伴行手术类型、手术时间、体外循环时间、主动脉阻断时间、术中失血量及输血量、术后呼吸机辅助时间、术后ICU入住时间、术后24 h引流量、术后引流管留置时间、术后并发症发生情况、术后住院时间、胸部切口长度、出院时胸部切口疼痛程度[视觉模拟量表(VAS)评分]。结果四组在人工瓣膜置换类型、瓣膜型号、手术时间、术中输血量、术后呼吸机辅助时间、术后ICU入住时间及术后并发症发生率方面无差异(P均>0.05);在伴行手术类型、体外循环时间、主动脉阻断时间、术中失血量、术后24 h引流量、术后引流管留置时间、术后住院时间、胸部切口长度及出院时VAS评分方面存在差异(P均<0.05)。进一步比较,FS组伴行左心耳结扎术的比例最高,体外循环时间和阻断时间最短,但术中失血量、术后24 h引流量最大,术后引流管留置时间、术后住院时间、胸部切口长度最长,出院时VAS评分亦最高(P均<0.05);PUS组上述指标总体介于FS组与其余两组之间;而RPLI组、RPTI组较FS组、PUS组上述指标则明显减少或缩短(P均<0.05),且RPTI组出院时VAS评分进一步低于RPLI组(P<0.05)。结论PUS、RPLI和RPTI主动脉瓣置换术均安全、有效,较传统FS术创伤小、疼痛轻、术后恢复快。其中,RPTI在减轻术后疼痛和促进快速康复方面更具优势。
Objective To compare the clinical efficacy of different minimally invasive small incisions in aortic valve replacement.Methods The clinical data from 187 patients with aortic valve disease who underwent aortic valve replace⁃ment were retrospectively analyzed.And they were divided into the full sternotomy(FS)group(50 cases),the partial up⁃per sternotomy(PUS)group(50 cases),the right parasternal longitudinal incision(RPLI)group(39 cases),and the right parasternal transverse incision(RPTI)group(48 cases)according to different surgical methods.The types and mod⁃els of artificial heart valves,types of accompanying surgery,operation time,cardiopulmonary bypass time,aortic occlu⁃sion time,postoperative blood loss,transfusion volume,ventilator use time,ICU stay time,24 h postoperative drainage,drain retention time,incidence of postoperative complications,postoperative hospital stay time,length of thoracic inci⁃sion,and degree of thoracic incision pain[visual analogue scale(VAS)score]at discharge were compared between the four groups.Results There were no significant differences between the four groups in terms of artificial valve replace⁃ment type,valve model,operative time,intraoperative blood transfusion volume,ventilator use time,ICU stay time,or in⁃cidence of postoperative complications(all P>0.05).Significant differences were observed in the following parameters:type of accompanying surgery,cardiopulmonary bypass time,aortic occlusion time,postoperative blood loss,24 h postoperative drainage,drain retention time,postoperative hospital stay time,length of thoracic incision,and VAS score at dis⁃charge(all P<0.05).Further comparisons revealed that the FS group had the highest proportion of concomitant left atrial appendage ligation,the shortest cardiopulmonary bypass and aortic occlusion time,and the highest postoperative blood loss and 24 h postoperative drainage;this group also exhibited the longest drain retention time,postoperative hospital stay time,and thoracic incision length,alongside the highest VAS score at discharge(all P<0.05).The PUS group generally fell between the FS group and the other two groups;the RPLI group and RPTI group demonstrated significantly lower val⁃ues for the aforementioned indicators compared with the FS and PUS groups(all P<0.05).Furthermore,the RPTI group exhibited a lower VAS score at discharge than the RPLI group(P>0.05).Conclusions Minimally invasive aortic valve replacement is safe and effective,offering advantages such as minimal trauma,mild pain,and rapid recovery.Patients un⁃dergoing aortic valve replacement through a right parasternal transverse incision will enjoy even more benefits.
作者
刘胜中
胡铁
魏大闯
向波
谭今
于涛
黄克力
LIU Shengzhong;HU Tie;WEI Dachuang;XIANG Bo;TAN Jin;YU Tao;HUANG Keli(Department of Cardiovascular Surgery,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China)
出处
《山东医药》
2026年第1期7-11,65,共6页
Shandong Medical Journal
基金
四川省自然科学基金(2023NSFSC0588)
四川省人民医院临床研究及转化基金(2021LY08)。
关键词
主动脉瓣置换术
微创手术
胸骨上段小切口
胸骨旁纵行小切口
胸骨旁横行小切口
aortic valve replacement
minimally invasive surgery
partial upper sternotomy
right parasternal lon⁃gitudinal incision
right parasternal transverse incision
