摘要
目的 总结2 8例胸腔镜辅助微创二尖瓣置换(MVR)术的经验。方法 右侧胸壁小切口(4～5cm) +两孔(胸腔镜、升主动脉阻闭钳入孔)。股动脉、静脉插管建立体外循环,特制的长阻闭钳阻闭升主动脉,冷血心脏停跳液顺行灌注保护心肌。结果 本组(胸腔镜组)无死亡。与同期一组(常规组) 33例正中开胸法MVR相比,体外循环82～14 6 (96±38)min对80～132 (92±31)min ,升主动脉阻闭37～76 (47±18)min对34～72 (45±13)min ,术后呼吸机辅助8 6～14 8(10. 2±3.1)h对8.3～15. 9(11.3±3.4 )h ,差异无统计学意义(P >0 0 5 ) ;而术后胸液引流量明显减少,5 0～2 30 (72±2 8)ml对70～4 6 0 (10.8±4 .2 )ml,术后住院时间明显缩短,8～12 (10.1±2 . 2 )d对10～2 8(15. 6±4 . 2 )d ,差异均有统计学意义(P <0.0 5 )。结论 胸腔镜辅助微创二尖瓣置换术较正中开胸法MVR创伤小、出血少、住院时间短。
Objective To summarize the experience of mitral valve replacement (MVR) using video-assisted thoracoscope. Methods 28 cases of MVR were performed through three right anterior ports under thoracoscopy using femorofemoral extracorporeal circulation. The aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold cardioplegic. 33 patients underwent routine open approach MVR as control group. Results There was no death and no morbidity directly related to this approach. Comparing with control group, time of extracorporeal circulation was 82～146 (96±38)min vs. 80～132(92±31)min, cross-clamped 37～76(47±18)min vs. 34～72(45±13)min and ventilation time were 8.6～14.8(10.2±3.1)h vs. 8.3～15.9(11.3±3.4)h . The volume of drainage was 50～230 (72±28)ml in VATS group while 70～460(108±4.2)ml in control group((P<0.01)), and hospital day were 8～12(10.1±2.2)d vs. 10～28(15.6±4.2)d (P<0.05). The pain in the VATS group was less postoperatively. Conclusion Video-assisted thoracoscopic MVR is a safe and effective technique with less drainage, shortened hospital stay and minor postoperative pain.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2005年第2期72-74,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
