胸部小切口瓣膜置换手术的临床研究

目的探讨各类胸部小切口瓣膜置换手术,评价其临床应用价值。方法自1995年12月至2004年9月体外循环下手术患者103（男60,女43）例,年龄1665岁。主动脉瓣置换（AVR）应用胸骨正中上半小切口19例;胸骨旁小切口2例;二尖瓣置换（MVR）应用胸骨正中下半切口30例;右胸前外侧小切口50例;另2例为三尖瓣置换（TVR）。结果103例患者术后死亡3例,病死率2.9%。术后胸腔引流量、输血量比同期常规胸骨正中切口瓣膜置换手术明显减少。痊愈出院的100例,切口甲级愈合。随访360个月,随访率91%。心功能比术前明显提高。结论胸部小切口瘢痕小,术后出血和输血量均明显减少,减少了住院时间和相关并发症。

Minimally invasive approach for valve replacement

AIM To assess the value of clinical application of minimally invasive approach for valve replacement.METHODS From December 1995 to September 2004,103 patients(60 males and 43 females,16 to 65 years old) underwent valve replacement operation with cardiopulmonary bypass.Aortic valve replacement was performed through upper partial sternotomy in 19 cases and through right parasternal incision in 2 cases.Mitral valve replacement was performed through lower partial sternotomy in 30 cases and through right anterolateral thoracotomy in 50 cases.Two patients received tricuspid valve replacement through right anterolateral thoracotomy.RESULTS There were 3 postoperative deaths with mortality of 2.9%.The amount of drainage and blood transfusion postoperatively was significantly reduced compared with traditional operations.Uneventful recovery was achieved in 100 cases.Ninety-one patients(91%) during 3 to 60 months follow-up had improved cardiac functions.CONCLUSION The minimally invasive approach for valve replacement proves to be safe with less surgical trauma and better cosmetic results.