右胸前外侧微小切口二尖瓣置换术临床剖析.docVIP

右胸前外侧微小切口二尖瓣置换术临床剖析 　　【摘要】目的 比较右胸前外侧微小切口与正中切口行二尖瓣置换术的临床疗效。方法 回顾性分析2011年1月至2013年8月行右胸前外侧微小切口二尖瓣置换术88例（微创组）与同期行胸骨正中切口二尖瓣置换术102例（传统组）患者的临床资料，并比较。结果 传统组死亡2例，微创组无死亡病例，两组患者术前资料（年龄、性别、体重、心胸比、体表面积、左室射血分数）的差异无统计学意义（P 0.05）；两组总手术时间、术后ICU停留时间的差异无统计学意义（P 0.05）；微创组体外循环时间及阻断时间要长于传统组（P 0.05）；微创组术后呼吸机辅助通气时间、术后一周切口长度均短于传统组（P 0.05），微创组术后心包、胸腔引流量要少于传统组（P 0.05）。结论 经右胸微小切口行二尖瓣置换术安全可行，具有美容效果，疗效肯定。 　　【关键词】微创手术；右胸前外侧小切口；二尖瓣置换术；体外循环 　　The clinical analysis of mitral valve replacement via right anterolateral minithoracotomy 　　Liu Hong-duan，Yu Feng-xu， Li Xin， Yang Fan，Deng Ming-bin （Department of Cardiothoracic Surgery， The Affiliated Hospital of Luzhou Medical College，Luzhou 646000） 　　Corresponding author： Li Xin. E-mail： hongduan@. 　　【Abstract】 Objective： To compare the clinic effect and safety of right anterolateral minithoracotomy and median sternotomy in the mitral valve replacement. Methods The clinical data from 88 patients underwent minimally invasive mitral valvue replacement via right anterolateral minithoracotomy（minimally invasive group） and 102 patients underwent median sternotomy （traditional group） from January 2011 and August 2013 in our institution were retrospectively analyzed. Results There were two deaths in traditional group， but no deaths in minimally invasive group. There were no statistical differences in the preoperative date and the time of total operation and intensive care unit stay in both groups （P 0.05）. The time of cardiopulmonary bypass and aortic cross clamp in minimally invasive group were significantly longer than those in traditional group （P 0.05）. However， the postoperative mechanical ventilation time， the chest tube drainage and the postoperative length of the thoracic incision were singnificant shorter in minimally invasive group than those in traditional group （P 0.05）. Conclusion Minimally invasive mitral valve replacement via right anterolateral minithoracotomy can be performed successfully and be achieving excellent cosmetic and clinical re