经右腋下小切口和胸骨正中切口二尖瓣成形术的比较

目的: 比较经右腋下小切口和胸骨正中切口行二尖瓣成形术的效果。方法: 回顾性分析2002年1月至2010年11月两种切口行二尖瓣成形术的93例病例资料，右腋下小切口组36例，胸骨正中切口组57例。两组病例皆在浅低温体外循环下进行二尖瓣修复。结果: 术后右腋下小切口组死亡1例（2.8%），胸骨正中切口组无死亡病例，两组远期均无死亡病例。右腋下小切口体外循环建立时间明显比胸骨正中切口组长（P <0.05）;右腋下小切口组术后24 h引流量、输血量均比胸骨正中切口组少（P均<0.05）;机械通气时间右腋下小切口组也比胸骨正中切口组短（P <0.05）。两组主动脉阻断时间、转流时间、总手术时间比较差异无统计学意义。结论: 右腋下小切口行二尖瓣成形术具有良好的美观和临床效果，其微创和美观的优势给二尖瓣成形术提供了另一选择。

Mitral valve repairment through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy

Objective: To compare the right vertical infra-axillary thoracotomy for mitral valve repairment with standard median sternotomy.Methods: A total of 93 patients,divided into a right vertical infra-axillary thoracotomy group and a standard median sternotomy group,who underwent mitral valvuloplasty from January 2002 to November 2010 were analyzed retrospectively.Results: Hospital mortality was 1 of 36(2.8%) patients in the right vertical infra-axillary thoracotomy group and none in the standard median sternotomy group.There was no late death in either group.The time to establish cardiopulmonary bypass was longer in the right vertical infra-axillary thoracotomy group(P<0.05).The right vertical infra-axillary thoracotomy group had less chest drainage during the postoperative 24 hours than the standard median sternotomy group and required less blood transfusion(P<0.05).Postoperative mechanical ventilation time was also less in the right vertical infra-axillary thoracotomy group(P<0.05).There were no statistical differences in aortic cross-clamp time,cardiopulmonary bypass time,and total operation time between the two groups.Conclusion: The right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results.It provides a good alternative to standard median sternotomy for mitral valve repairment.