心血管外科杂志(电子版) 2016年6月,5卷2期

临床研究

右胸小切口与标准胸骨正中切口在心脏瓣膜成形术中的比较研究

王怡轩 陈 思 刘金平 刘隽炜

430022 武汉,华中科技大学同济医学院附属协和医院心血管外科
刘隽炜,Email: liujuanwei@yahoo.com

摘要:目的 探讨右胸小切口(RMT)与标准胸骨正中切口(SMS)手术方法在心脏瓣膜成形术中的应用和近期临床疗效。方法 采用回顾 性分析法纳入2011年5月至2014年10月湖北省武汉市协和医院行直视下心脏瓣膜成形术的患者共270例,其中RMT组128例,SMS组142例。观察两 组患者术前病史资料、体外循环时间、主动脉阻断时间、总输血量、术后ICU停留时间、术后住院时间、术后并发症,并随访转归情况。结果 RMT组和SMS组患者一般情况具有可比性,均能满意有效地完成瓣膜成形术。两组均有2例院内死亡,在再次开胸、急性肾衰竭、脑血管意外术 后并发症发生率方面差异无统计学意义(P>0.05);RMT组在体外循环时间、主动脉阻断时间较SMS组长(P<0.05),而术后ICU停留时间、 术后住院时间较SMS组短(P<0.05),总输血量和术后机械通气时间也较少(P<0.05);术后1年随访两组患者在院外死亡率及再手术率方面 差异无统计学意义(P>0.05)。结论 经RMT行瓣膜成形术安全可行,相对于行SMS术患者具有术后创伤小、恢复快、住院时间短、切口美观 等优势,可取得与SMS完全相同的近期手术效果,在无禁忌证的情况下有望成为部分患者瓣膜成形手术中的常规选择。

关键词:心脏瓣膜假体植入; 外科手术,微创性; 右胸微创切口

国家自然科学基金青年科学基金(81400270)

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(编辑:张澜 收稿日期:2016-02-22)