天津医药

• 临床论丛 •    

再次二尖瓣手术与微创应用

张玉海,谷天祥,师恩祎,王春   

  1. 中国医科大学附属第一医院心脏外科
  • 收稿日期:2012-04-10 修回日期:2012-08-14 出版日期:2012-12-15 发布日期:2012-12-15
  • 通讯作者: 谷天祥

  • Received:2012-04-10 Revised:2012-08-14 Published:2012-12-15 Online:2012-12-15

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摘要： 目的：总结再次二尖瓣手术中应用右胸前外侧小切口及微创技术的意义及作用。方法：13例心脏外科术后再次出现二尖瓣病变患者接受右胸小切口微创二尖瓣置换术。静脉吸入复合麻醉，单肺通气。右侧腹股沟切口，股动、静脉插管，建立体外循环，加装负压调节器维持静脉回流。右胸前外侧4-6cm切口，经第3或第4肋间入胸，左心房切口直视下行二尖瓣置换术。结果：全组病例行生物瓣置换2例，机械瓣置换10例，二尖瓣成形1例，平均体外循环时间111.5±25.6(78-167)分钟。1例术后早期死于多器官功能衰竭，其余12例患者均痊愈出院。平均机械通气时间11.2±2.3(7-14)小时，平均ICU停留时间3.5±1.7(2-9)天，平均住院时间12.7±1.5(9-15)天。结论：对于心脏术后再次二尖瓣手术患者，采用右胸前外侧小切口及“No Touch”微创二尖瓣置换术能够避免再次正中开胸的手术风险，简化手术，是安全，可靠的手术方式。 关键词：微创瓣膜手术 “No Touch”技术

关键词: 微创瓣膜手术, “No, Touch”技术

Abstract: Objective: The objective is to summarize the successful experience of minimally invasive surgery via right minithoractomy for reoperative mitral valve replacement. Methods: 13 patients with mitral valve disease after primary cardiac surgery received minimally invasive mitral valve replacement via right minithoractomy. All patients received intravenous inhalation anesthesia and one-lung ventilation. Cardiopulmonary bypass was performed through right femoral artery and vein cannulation. Sufficient venous drainage was maintained by a suitable negative-pressure. A main surgical wound about 4-6cm was made through the third or forth costal space on the anterolateral side of the right chest. Mitral valve was replaced directly through the left atrium approach on beating heart without aortic artery clamping. Result: Tissue valves were replaced in 2 patients while the other 13 patients received mechanical prostheses. The average CPB time was 111.5±25.6 (78-167) min. 12 patients recovered successfully except 1 patient died on the 9th day after the operation due to multiple organ failure. Mean mechanical ventilation time was 11.2±2.3 (7-14) h. Mean ICU stay time was 3.5±1.7(2-4) d and the mean hospital stay time was 12.7±1.5(9-15) d. Conclusion: For patients receiving reoperative mitral valve replacement, minimally invasive surgery via right minithoractomy “No Touch”technique which can avoid reopening of the sternum is feasible and safe. Keyword Minimally invasive valve surgery “No Touch”technique

Key words: Keyword, Minimally invasive valve surgery, “No Touch”technique