胸腔镜结合右胸前外侧微创切口在二尖瓣置换术中的应用价值分析
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摘要
目的探讨二尖瓣置换术中实施胸腔镜下右胸前外侧微创切口的临床价值。方法以随机数字表法将86例行二尖瓣置换术患者分为观察组43例,对照组43例,观察组行胸腔镜下右胸前外侧微创切口,对照组行胸正中切口,观察两组治疗效果,比较术中及术后相关指标及术后并发症发生情况。结果 2组均顺利完成手术,未出现死亡病例,术后复查心脏彩超显示人工心脏瓣膜功能良好;观察组术中出血量、胸腔引流量明显少于对照组(P<0.05);观察组术后ICU停留时间、术后住院时间明显短于对照组(P<0.05),观察组手术时间长于对照组,差异有统计学意义(P<0.05);观察组术后并发症发生率为4.65%,对照组术后并发症发生率为9.30%,2组差异无统计学意义(P>0.05),患者均未出现严重并发症。结论二尖瓣置换术中实施胸腔镜下右胸前外侧微创切口,效果满意,可减少术中出血及胸腔引流,缩短术后恢复时间,且安全性高,值得推广。
Objective To investigate the clinical value of minimally invasive thoracoscopic right anterolateral incision in mitral valve replacement. Methods A total of 86 patients undergoing mitral valve replacement were randomly divided into the observation group(43 cases) and the control group(43 cases). The thoracoscopic lateral right chest anterior minimally invasive incision was conducted in observation group. The median chest incision was conducted in control group. The therapeutic effects, intraoperative and postoperative related indicators, postoperative complications were observed in two groups of patients. Results Both groups were successfully completed the operation, no death case, postoperative echocardiography showed that the artificial heart valve function was good. The bleeding volume, thoracic drainage volume, ICU stay time and hospitalization time in the observation group were significantly less than those in the control group(P<0.05). The incidence of complications in the observation group and the control group were 4.65% and 9.30%, respectively(P>0.05). No serious complications occurred in the control group. Conclusion In mitral valve replacement, the minimally invasive incision on the lateral side of the right chest under the thoracoscopy has a satisfactory effect, which can reduce intraoperative bleeding and thoracic drainage, shorten postoperative recovery time, and has a high safety, which is worthy of promotion.
Objective To investigate the clinical value of minimally invasive thoracoscopic right anterolateral incision in mitral valve replacement. Methods A total of 86 patients undergoing mitral valve replacement were randomly divided into the observation group(43 cases) and the control group(43 cases). The thoracoscopic lateral right chest anterior minimally invasive incision was conducted in observation group. The median chest incision was conducted in control group. The therapeutic effects, intraoperative and postoperative related indicators, postoperative complications were observed in two groups of patients. Results Both groups were successfully completed the operation, no death case, postoperative echocardiography showed that the artificial heart valve function was good. The bleeding volume, thoracic drainage volume, ICU stay time and hospitalization time in the observation group were significantly less than those in the control group(P<0.05). The incidence of complications in the observation group and the control group were 4.65% and 9.30%, respectively(P>0.05). No serious complications occurred in the control group. Conclusion In mitral valve replacement, the minimally invasive incision on the lateral side of the right chest under the thoracoscopy has a satisfactory effect, which can reduce intraoperative bleeding and thoracic drainage, shorten postoperative recovery time, and has a high safety, which is worthy of promotion.
引文
[1] LAN H, ChENG Y G, JIA B C, et al. Clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement: a series of 634 cases[J]. Zhonghua Wai Ke Za Zhi, 2016, 54(8):609-611.
[2] 王珊, 江凤英, 许友. 胸腔镜微创二尖瓣成形术的手术配合体会[J]. 皖南医学院学报, 2018,24(1):97-99.
[3] 李鹏, 李亚雄, 钱旭,等. 胸腔镜辅助右胸微小切口二尖瓣置换术临床分析[J]. 昆明医科大学学报, 2017, 38(3):123-126.
[4] 韩杰, 陈经勇, 斯焱,等. SuperPATH切口微创人工全髋关节置换术临床应用价值分析[J]. 中国现代手术学杂志, 2017, 21(4):283-287.
[5] 郭能瑞, 孙鹏飞, 张森,等. 闭式体外循环辅助下经右胸前外侧小切口微创心脏外科手术的临床总结[J]. 中国循环杂志, 2016, 31(9):888-891.
[6] ZHANG Q, CHEN Q, LIN Z, et al. Thoracoscope-assisted mitral valve replacement with a small incision in the right chest: A Chinese Single Cardiac Center experience[J]. Med Sci Monitor, 2018, 24(3):1054-1063.
[7] SCHWANN T A, HABIB R H, SURI R M, et al. Variation in warfarin use at hospital discharge after Isolated bioprostheticmitral valve replacement-an analysis of the society of thoracic surgeons adult cardiac surgery database[J]. Chest, 2016, 150(3):597-605.
[8] 刘治元,欧斌,黄思纳,等.右胸微创二尖瓣置换术治疗二尖瓣关闭不全或(和)狭窄的临床研究[J].中国循证心血管医学杂志,2017,9(1):84-87.
[9] 李鹏,李亚雄,杨应南,等.右胸小切口胸腔镜辅助二尖瓣置换44例[J].中国微创外科杂志,2015,15(9):822-823,833.
[10] 朱家全, 鲍春荣, 张俊文,等. 右胸前外侧小切口微创主动脉瓣置换的倾向评分匹配研究[J]. 中国心血管病研究, 2018, 16(4):353-357.
[11] 龙艳丽, 周榕, 祁明,等. 胸腔镜辅助微创二尖瓣及主动脉瓣双瓣置换术14例临床分析[J]. 心肺血管病杂志, 2016, 35(1):38-40.
[12] 王现强, 王德, 刘凯飏,等. 经皮股静脉插管在微创主动脉瓣置换术中的应用效果[J]. 中国体外循环杂志, 2018, 16(1):25-28.
[2] 王珊, 江凤英, 许友. 胸腔镜微创二尖瓣成形术的手术配合体会[J]. 皖南医学院学报, 2018,24(1):97-99.
[3] 李鹏, 李亚雄, 钱旭,等. 胸腔镜辅助右胸微小切口二尖瓣置换术临床分析[J]. 昆明医科大学学报, 2017, 38(3):123-126.
[4] 韩杰, 陈经勇, 斯焱,等. SuperPATH切口微创人工全髋关节置换术临床应用价值分析[J]. 中国现代手术学杂志, 2017, 21(4):283-287.
[5] 郭能瑞, 孙鹏飞, 张森,等. 闭式体外循环辅助下经右胸前外侧小切口微创心脏外科手术的临床总结[J]. 中国循环杂志, 2016, 31(9):888-891.
[6] ZHANG Q, CHEN Q, LIN Z, et al. Thoracoscope-assisted mitral valve replacement with a small incision in the right chest: A Chinese Single Cardiac Center experience[J]. Med Sci Monitor, 2018, 24(3):1054-1063.
[7] SCHWANN T A, HABIB R H, SURI R M, et al. Variation in warfarin use at hospital discharge after Isolated bioprostheticmitral valve replacement-an analysis of the society of thoracic surgeons adult cardiac surgery database[J]. Chest, 2016, 150(3):597-605.
[8] 刘治元,欧斌,黄思纳,等.右胸微创二尖瓣置换术治疗二尖瓣关闭不全或(和)狭窄的临床研究[J].中国循证心血管医学杂志,2017,9(1):84-87.
[9] 李鹏,李亚雄,杨应南,等.右胸小切口胸腔镜辅助二尖瓣置换44例[J].中国微创外科杂志,2015,15(9):822-823,833.
[10] 朱家全, 鲍春荣, 张俊文,等. 右胸前外侧小切口微创主动脉瓣置换的倾向评分匹配研究[J]. 中国心血管病研究, 2018, 16(4):353-357.
[11] 龙艳丽, 周榕, 祁明,等. 胸腔镜辅助微创二尖瓣及主动脉瓣双瓣置换术14例临床分析[J]. 心肺血管病杂志, 2016, 35(1):38-40.
[12] 王现强, 王德, 刘凯飏,等. 经皮股静脉插管在微创主动脉瓣置换术中的应用效果[J]. 中国体外循环杂志, 2018, 16(1):25-28.