| 摘要: |
| ［摘要］ 目的 总结右侧胸骨旁纵行小切口主动脉瓣置换术的临床经验，并评价其安全性和效果。方法 选择2014-12～2019-03在四川省人民医院心脏外科中心接受了右侧胸骨旁第2～3肋间隙纵行小切口主动脉瓣置换术治疗的19例主动脉瓣病变患者。其中男10例，女9例。所有患者通过股动脉、股静脉插管建立外周体外循环，使用负压辅助静脉引流，并通过右上肺静脉插入左心室引流管；术中直视下切除病变主动脉瓣膜，间断缝合瓣环，植入人工瓣膜行主动脉瓣置换术。结果 所有患者的手术顺利完成，无扩大手术切口或转为前正中开胸病例。手术时间（256.05±47.54）min，体外循环时间（110.79±23.01）min，主动脉阻断时间（71.37±14.93）min，术中失血量（231.58±129.33）ml，术毕回输自体血（314.21±77.84）ml，库血使用量（257.89±238.20）ml。有8例（42.11%）患者未输库存血。术后呼吸机辅助时间（7.95±2.57）h，术后监护室停留时间（29.16±10.76）h，术后引流管安置时间（3.47±0.77）d。患者手术切口长度（4.93±0.57）cm，术后无切口愈合不良病例发生。1例患者术中停机后发现主肺动脉间隙出血，直接修补困难，再次并行循环放空心脏后修补成功。1例患者术后并发右下肺不张，经治疗后复张。所有患者均痊愈出院。术后住院时间（8.58±2.24）d。患者术后随访（25.68±20.07）个月，生活质量良好，心功能恢复至Ⅰ级；心脏彩超提示人工瓣膜未见明显异常，左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）均较术前显著改善（P<0.05）。结论 通过股动脉、股静脉插管建立外周体外循环进行右侧胸骨旁纵行小切口主动脉瓣置换术，创伤小、并发症少、术后恢复快、效果良好，值得在有经验的心脏中心推广。 |
| 关键词: 心脏外科 微创 胸骨旁纵行小切口 主动脉瓣置换术 |
| DOI：10.3969/j.issn.1674-3806.2019.10.06 |
| 分类号:R 615 |
| 基金项目:中国科学院2014年度“西部之光”人才培养计划资助课题（编号：30305031013） |
|
| Clinical study of minimally invasive aortic valve replacement through right parasternal longitudinal small incision |
|
LIU Sheng-zhong, WEI Da-chuang, TAN Jin, et al.
|
|
Cardiac Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, Sichuan Translational Medicine Hospital, Chinese Academy of Sciences, Affiliated Hospital of University of Electronic Science and Technology, Chengdu 610072, China
|
| Abstract: |
| ［Abstract］ Objective To summarize the clinical experience of minimally invasive aortic valve replacement through right parasternal longitudinal small incision, and to evaluate its safety and curative effect. Methods From December 2014 to March 2019, 19 patients including 10 males and 9 females with aortic valve disease underwent minimally invasive aortic valve replacement through right parasternal longitudinal small incision in Cardiac Surgery Center of Sichuan Provincial People′s Hospital. Cardiopulmonary bypass was established for all the patients through femoral artery and vein. The vacuum assisted venous drainage technology was used for enhancing the venous drainage. The left ventricular drainage cannula was inserted to the left ventricle through the right superior pulmonary vein. Surgical resection of the diseased aortic valve was performed under direct vision, and interrupted suture was used for the aortic valve replacement. An artificial valve was implanted for the aortic valve replacement. Results All the patients underwent surgery successfully, and none of them underwent enlarged incision or anterior median thoracotomy. The operation time was (256.05±47.54)minutes, and the cardiopulmonary bypass time was (110.79±23.01)minutes. The aortic cross-clamping time was (71.37±14.93)minutes. The volume of blood loss during operation was (231.58±129.33)milliliters. The transfusion volume of autoblood after operation was (314.21 ±77.84)milliliters. The transfusion volume of bank blood was (257.89 ±238.20)milliliters, and there were 8 patients(42.11%) without bank blood transfusion. The postoperative ventilator support time was (7.95±2.57)hours. The postoperative intensive care unit stay time was (29.16±10.76)hours. The postoperative drainage tube placement time was (3.47±0.77)days. The length of incision was (4.93±0.57)centimeters. Poor healing of incision was not found in all the patients. Bleeding in the aortic and pulmonary artery space after stopping cardiopulmonary bypass was found in 1 case whose direct repair was difficult and the repair was successful after direct repair of the heart and again parallel circulation emptying. Right lower pulmonary atelectasis occurred in 1 case after operation and lung recruitment was achieved after treatment. All the patients were cured and discharged from hospital. The postoperative hospital stay time was (8.58±2.24)days. The patients were followed up for (25.68±20.07)months after operation, and the quality of life was good, and their heart function recovered to grade Ⅰ. Color Doppler ultrasound showed no obvious abnormalities of the artificial valves. The left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDD) were significantly improved compared with those before the operation(P<0.05). Conclusion Minimally invasive aortic valve replacement through right parasternal longitudinal small incision with peripheral cardiopulmonary bypass established through femoral artery and vein is less invasive, and has fewer complications, faster recovery and better effect. It is worthy to be applied in experienced cardiac surgery centers. |
| Key words: Cardiac surgery Minimal invasion Parasternal longitudinal small incision Aortic valve replacement |
