目的 比较右胸小切口与胸骨正中切口二尖瓣置换术的临床疗效.方法 回顾性分析2009年9月至2012年5月行右胸小切口二尖瓣置换术128例(微创组)与同期行胸骨正中切口二尖瓣置换术120例(传统组)的临床资料,并进行对比研究.结果 两组在年龄、性别、心功能分级、瓣膜病变、合并心脏疾病等方面的差异无统计学意义(P>0.05);两组术后并发症(再次开胸止血、新发房颤、肺炎、脑血管意外、伤口愈合不良等)发生率差异亦无统计学意义(P>0.05).围术期微创组死亡1例,传统组死亡2例.微创组的体外循环、主动脉阻断时间较传统组长(P<0.05),而术后ICU住院、术后机械通气、术后住院时间较传统组短(P<0.05),术后引流量及输血量也较传统组少(P<0.05).术后微创组随访(15.0±4.8)个月,传统组(23.3±3.9)个月.两组均无院外死亡病例,无瓣周漏、脑血管意外、机械瓣故障、溶血等严重并发症发生,两组心功能分级差异无统计学意义(P>0.05).结论 右胸小切口二尖瓣置换手术安全、有效,值得临床推广应用.
Objective To compare the effect and complications of right anterolateral minithoracotomy and median sternotomy in mitral valve replacement.Methods Clinical datas from 128 patients (minimally invasive group) received right anterolateral mini-thoracotomy and 120 patients (traditional group) underwent median sternotomy from Sept 2009 to May 2012 were analyzed retrospectively.Results There were not significant differences in the comparison of the preoperative datas (P >0.05).There were no significant differences in re-exploration for bleeding rate,new onset atrial fibrillation,pneumonia,cerebrovascular accident,septic wound of complications,phrenic nerve injury(P > 0.05).Minimally invasive group had 1 death and traditional group had 2 death cases.The minimally invasive group were longer than the traditional group in the times of extracorporeal circulation and aortic clamp(P<0.05).But ICU stay,postoperative mechanical ventilation time,postoperative hospitalization time in the minimally invasive group were shorter than in the traditional group (P < 0.05).The traditional grouphad more blood loss and needed more blood transfusion than the minimally invasive group(P <0.05).Postoperative follow-up results:the mean follow-up time of minimally invasive group was (15.0 ± 4.8) months,and the traditional group was (23.3 ±3.9) months.There were not death case,and people who had perivalvular leakage or cerebrovascular accident,mechanical valve failure,hemolytic on the both groups.Conclusion The right anterolateral mini-thoracotomy in the mitral valve replacement is safe and effective.