胸腔镜辅助二尖瓣成形术34例临床分析

目的：总结胸腔镜辅助二尖瓣成形术的有效性及安全性,分析手术要点,探讨手术方法及临床疗效.方法：于2010年1月至2013年2月,开展胸腔镜辅助二尖瓣成形术34例,男性20例,女性14例,年龄23～ 64岁,平均（42±17）岁,平均体质量（57.5±14.5）kg.瓣膜退行性病变25例,先天性二尖瓣病变4例,感染性心内膜炎4例,风湿性心脏病1例.术前超声心动图提示：二尖瓣关闭不全（中-重度）11例,二尖瓣关闭不全重度23例.所有病例均采用右股动脉插供血管,右股静脉和（或）上腔静脉插引血管建立体外循环.顺行灌注保护心肌,经右侧胸壁小切口（4 ～5 cm）＋两孔法在胸腔镜下完成心脏手术.结果：全组无死亡病例,且与传统开胸组相比较,术后呼吸机辅助时间短,术后胸腔引流量少,术后住院时间短,输血量少.术后早期超声心动图检查二尖瓣反流面积：无反流或轻微反流（＜1.0cm2）19例,轻度反流（1.0～4.0 cm2）12例,中度反流（4.0 ～8.0 cm2）2例.随访3～ 18个月,随访30例,随访率90.9％,随访示左心房内径和左心室舒张末内径比术前均明显缩小.结论：胸腔镜辅助二尖瓣成形术临床效果满意,创伤小,美容效果好,符合现代健康理念.

Clinical analysis of video-assisted thoracoscopic surgery for mitral valvuloplasty in 34 cases

Objective： To summarize the efficiency and safety of the video-assisted thoracoscopic sur- gery for mitral valvuloplasty. Methods ： From Jan. 2010 to Feb. 2013, 34 cases performed video-assisted tho- raeoseopic mitral valvuloplasty operation including 25 valvular degeneration eases, 4 congenital mitral valve dis- ease cases, 4 infective endocarditis cases and 1 rheumatic case respectively. Preoperative eehoeardiography showed moderate to severe mitral valve insufficiency in 11 cases, severe insufficiency in 23 cases. The establish- ment of cardiopulmonary bypass （CPB）were accessed from right femoral artery and vein cannula or superior ve- nae cava cannula in all cases. Antegrade perfusion was applied in all patients for myocardial protection. The operation was accomplished through one small right thoracotomy incision （4 -5 cm） and two holes with the tho- racoscope. Results： There was no death. The ventilation duration time is shorter, postoperative chest drainage volume is less, postoperative hospitalization time is shorte and blood transfusion is fewer compared with the tradi- tional thoracotomy group. No regurgitation（ 〈 1.0 mL/cm2）in 19 cases, mild regurgitation（ 1.0 -4. 0 cm2 ）in 12 cases, moderate mitral regurgitation （4.0 -8.0 cm2） in 2 cases showed by the ultrasound after the operation. The follow-up was 3 - 18 months, showed the left atrial diameter and left ventricular end-diastolic diameter re- duced significantly compared with preoperative parameters. Conclusion： Video-assited thoracoscopic mitral val- vuloplasty operation is an effective clinical metho with less invasive and beautiful incision.