右胸前外侧微创切口和胸骨正中切口心脏瓣膜手术比较研究
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摘要
目的
通过回顾性研究,比较152例右胸前外侧微创切口(RM,n=76)与标准胸骨正中切口(SMS,n=76)行瓣膜手术的手术效果。
方法
本研究属单中心回顾性队列研究,2009年7月-2009年12月76例患者在本院经右胸前外侧微创切口行微创瓣膜手术(微创组),与同期进行的76例经标准胸骨正中切口行传统瓣膜手术(传统组)进行比较。
结果
1、术前资料结果：微创组完成MVR 28例,MVP 24例,AVR 24例；传统组完成MVR 30例,MVP 22例,AVR 24例。
2、术中资料结果：微创组无院内死亡,传统组2例院内死亡(2.6%,2／76),两者无显著差异(P>0.05)；两者在术后再次开胸止血、新发房颤、肺炎、脑血管意外、伤口愈合不良等术后并发症发生率无显著差异(P>0.05)；微创组在手术时间、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时间、术后机械通气时间、术后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,两者有显著差异(P<0.05)。
3、术后随访结果：随访3-9月,平均5.5月,随访率96%。微创组1例MVR患者术后1周因颅内出血死亡,死亡率1.3%,传统组无死亡病例,两者无显著差异(P>0.05)；微创组1例MVR患者术后3月随访体表心超发现轻度瓣周漏(3.6%,1／28),传统组术后随访无殊；微创组1例MVP患者术后3月随访体表心超示中度返流,两组其他MVP患者无或轻度返流；微创组平均恢复时间较传统组短,两者有显著差异(P<0.05)。
结论
经右胸前外侧微创切口行微创瓣膜手术安全有效,有较好的美容效果,术后恢复情况较标准胸骨正中切口更快、更好,值得临床推广应用。
Objective
We sought to evaluate the potential benefits of minimally invasive approaches for surgery of isolated aortic and mitral valve disease, this retrospective study review our results and experience with a right mini-thorctomy(RM) technique for vavle surgery compared with standard median sternotomy(SMS).
Methods
Between, July 2009 and December 2009,76 patients accepted minimally invasive valve surgery through RM (minimally invasive group).This group was compared with 76 patients who underwent valve surgery though SMS during the same period (traditional group).
Results
1 In the minimally invasive group, an RM incision though the forth intercostal space was used in 28/24 MVR/MVP, an RM incision in the third intercostal space was used in 24 AVR; In the traditional group, the standard surgery procedure was finished in 30/22/24 MVR/MVP/AVR.
2 Operative mortality was 0%(0/76) in the minimally invasive group and 2.6%(2/76) in the traditional group (P>0.05).There were no statistical differences in the re-exploration for bleeding rate、new onset atrial fibrillation、pneumonia、neurological events、septic wound complications (P>0.05); The minimally invasive group had less chest drainage than traditional group and required less blood transfusion (P<0.05) Postoperative mechanical ventilation time、ICU stay、hospital stay after operation was shorter in the minimally invasive group than in the traditional group (P<0.05),but the minimally invasive group was longer in the operation time、CPB time、aortic-clamp time (P<0.05)
3 The mean follow-up duration was 5.5 months(range 3～9 months),and the follow-up rate 96%.There was one late death in the minimally invasive mitral valve replace one week after discharge due to cerebral hemorrhage, and the death rate in the minimally invasive group was 1.3%,then there was no late death in the traditional group (P>0.05).There was one perivalvular leakage in the minimally invasive mitral valve replace and was treated pharmacotherapy. The follow-up TTE show that there was no mitral valve regurgitation more than no or trivial except one in the minimally invasive group. Patients returned to normal activity more quickly with RM than SMS (P<0.05)
Conclusion
The MIVS though mini-thoracotomy can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy.
通过回顾性研究,比较152例右胸前外侧微创切口(RM,n=76)与标准胸骨正中切口(SMS,n=76)行瓣膜手术的手术效果。
方法
本研究属单中心回顾性队列研究,2009年7月-2009年12月76例患者在本院经右胸前外侧微创切口行微创瓣膜手术(微创组),与同期进行的76例经标准胸骨正中切口行传统瓣膜手术(传统组)进行比较。
结果
1、术前资料结果：微创组完成MVR 28例,MVP 24例,AVR 24例；传统组完成MVR 30例,MVP 22例,AVR 24例。
2、术中资料结果：微创组无院内死亡,传统组2例院内死亡(2.6%,2／76),两者无显著差异(P>0.05)；两者在术后再次开胸止血、新发房颤、肺炎、脑血管意外、伤口愈合不良等术后并发症发生率无显著差异(P>0.05)；微创组在手术时间、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时间、术后机械通气时间、术后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,两者有显著差异(P<0.05)。
3、术后随访结果：随访3-9月,平均5.5月,随访率96%。微创组1例MVR患者术后1周因颅内出血死亡,死亡率1.3%,传统组无死亡病例,两者无显著差异(P>0.05)；微创组1例MVR患者术后3月随访体表心超发现轻度瓣周漏(3.6%,1／28),传统组术后随访无殊；微创组1例MVP患者术后3月随访体表心超示中度返流,两组其他MVP患者无或轻度返流；微创组平均恢复时间较传统组短,两者有显著差异(P<0.05)。
结论
经右胸前外侧微创切口行微创瓣膜手术安全有效,有较好的美容效果,术后恢复情况较标准胸骨正中切口更快、更好,值得临床推广应用。
Objective
We sought to evaluate the potential benefits of minimally invasive approaches for surgery of isolated aortic and mitral valve disease, this retrospective study review our results and experience with a right mini-thorctomy(RM) technique for vavle surgery compared with standard median sternotomy(SMS).
Methods
Between, July 2009 and December 2009,76 patients accepted minimally invasive valve surgery through RM (minimally invasive group).This group was compared with 76 patients who underwent valve surgery though SMS during the same period (traditional group).
Results
1 In the minimally invasive group, an RM incision though the forth intercostal space was used in 28/24 MVR/MVP, an RM incision in the third intercostal space was used in 24 AVR; In the traditional group, the standard surgery procedure was finished in 30/22/24 MVR/MVP/AVR.
2 Operative mortality was 0%(0/76) in the minimally invasive group and 2.6%(2/76) in the traditional group (P>0.05).There were no statistical differences in the re-exploration for bleeding rate、new onset atrial fibrillation、pneumonia、neurological events、septic wound complications (P>0.05); The minimally invasive group had less chest drainage than traditional group and required less blood transfusion (P<0.05) Postoperative mechanical ventilation time、ICU stay、hospital stay after operation was shorter in the minimally invasive group than in the traditional group (P<0.05),but the minimally invasive group was longer in the operation time、CPB time、aortic-clamp time (P<0.05)
3 The mean follow-up duration was 5.5 months(range 3～9 months),and the follow-up rate 96%.There was one late death in the minimally invasive mitral valve replace one week after discharge due to cerebral hemorrhage, and the death rate in the minimally invasive group was 1.3%,then there was no late death in the traditional group (P>0.05).There was one perivalvular leakage in the minimally invasive mitral valve replace and was treated pharmacotherapy. The follow-up TTE show that there was no mitral valve regurgitation more than no or trivial except one in the minimally invasive group. Patients returned to normal activity more quickly with RM than SMS (P<0.05)
Conclusion
The MIVS though mini-thoracotomy can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy.
引文
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70. Davide Ricci b,Carlo Pellegrini. Port-access surgery as elective approach for mitral valve operation in re-do procedures. European Journal of Cardio-thoracic Surgery, article in press.
71. Joerg Seeburger, Michael A. Borger, Volkmar Falk,Friedrich W. Mohr. Minimally Invasive Mitral Valve Surgery After Previous Sternotomy:Experience. Ann Thorac Surg 2009;87:709-714
72. Yoshikazu Suzuki, Francis D. Pagani and Steven F. Bolling. Left Thoracotomy for Multiple-Time Redo Mitral Valve Surgery Using On-Pump Beating Heart Technique. Ann Thorac Surg 2008;86:466-471
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75. L. Wiley Nifong, W.R. Chitwood. Robotic mitral valve surgery:A United States multicenter trial. J Thorac Cardiovasc Surg 2005; 129:1395-1404
76. W. Randolph Chitwood Jr.Evelio Rodriguez, L. Wiley Nifong. Robotic mitral valve repairs in 300 patients:a single-center experience. The Journal of Thoracic and Cardiovascular Surgery,2008,136(2),P.436-441