微创二尖瓣置换术与胸骨正中切口手术比较分析

摘要

Objective To explore and evaluate the feasibility, safety of right anterolateral mini-thoracotomy in mitral valve replacement. Methods Clinical data from 45 patients(minimally invasive group)received right anterolateral mini-thoracotomy from December 2010 to October 2014, and 22 patients(traditional group)underwent median sternotomy from January 2014 to October 2014 were analyzed retrospectively.The operative procedures and Postoperative complications were compared between the two groups.Results There were not significant differences in the comparison of the preoperative datas(P>0.05). There were no significant differences in re-exploration for bleeding rate, new onset atrial fibrillation, pneumonia, cerebrovascular accident, septic wound of complications, phrenic nerve injury(P>0.05). The minimally invasive group were longer than the traditional group in the times of extracorporeal circulation and aortic clamp(P<0.05). But ICU stay,postoperative mechanical ventilation time,postoperative hospitalization time in the minimally invasive group were shorter than in the traditional group(P<0.05). The traditional group had more blood loss and needed more blood transfusion than the minimally invasive group(P<0.05). There were not significant differences between the two groups(P>0.05). The differences in the cardiac function classification between minimally invasive group and traditional group were not significant(P>0.05).Conclusion The right anterolateral mini-thoracotomy in the mitral valve replacement is safe and effective. It can be performed with good cosmetic and clinic effectiveness. The surgeon should strictly control operation indications, choice cases, abide by the operation norm, take individual therapeutic Methods in the minimally invasive surgery.%目的 探讨右胸小切口二尖瓣置换术的疗效和安全性.方法 回顾性分析22例胸骨正中切口二尖瓣置换术(传统手术组)和45例右胸小切口二尖瓣置换术(微创手术组)的临床资料.比较两组手术相关指标、近期并发症及转归情况.结果 两组术后并发症发生率比较差异无统计学意义(P>0.05).微创组的体外循环时间、主动脉阻断时间较传统组长(P<0.05),而术后ICU住院时间、机械通气时间、住院时间较传统组短(P<0.05),术后引流量、用血量微创组较传统组少(P<0.05).在抗凝过度、三尖瓣关闭不全方面差异无统计学意义(P>0.05).两组心功能分级差异无统计学意义(P>0.05).结论 右胸小切口瓣膜手术安全、有效,创伤小、恢复快,值得临床推广应用.