部分体外循环胸骨旁小切口心脏不停跳二尖瓣置换术的研究

目的探讨部分体外循环胸骨旁小切口心脏不停跳二尖瓣置换术的临床意义和价值。方法2007—10—2012-03将风湿性心脏病二尖瓣病变需行二尖瓣置换的80例患者随机分为研究组（A组）和对照组（B组），各40例。A组采用经右前胸小切口（6—8cm）第四肋间进胸，行右股动、静脉插管建立部分体外循环，无须显露和阻断升主动脉。B组采用常规经右胸前外侧切口（12～18cm）第四肋间进胸，显露并插升主动脉灌注管和上、下腔静脉引流管建立体外循环，不阻断升主动脉。两组均在心脏不停跳下完成二尖瓣置换手术。结果切口长度：A组（6．7±0．61）cm，B组（16．51±1．52）cm（P〈0．05）；心脏血管手术时间：A组（74±12．00）min，B组（71±11．00）min（P〉0．05）；体外循环时间：A组（58±13．30）min，B组（56±11．60）min（P〉0．05）；出血量：A组（183±56）ml，B组（196±43）ml（P〉0．05）；ICU停留时间：A组（36±8．5）h，B组（37±7．8）h（P〉0．05）；术后住院时间：A组（12±2．3）d，B组（13±2．9）d（P〉0．05）。全组无伤口感染，无气栓栓塞和神经系统并发症，无主动脉、股动脉和静脉损伤并发症，均恢复顺利。心功能恢复两组差异无统计学意义（P〉0．05）。结论部分体外循环胸骨旁小切口心脏不停跳二尖瓣置换术能进一步缩小胸部切口的长度、减少创伤、减轻疼痛和降低并发症发生率，达到恢复快和切口美观的效果，为临床多提供一种微创的手术方法，而且容易推广。

Study on mitral valve replacement in beating heart through parasternal minimal invasive incision by partly cardiopulmonary bypass

Objective To study on the clinical meaning of mitral valve replacement（MVR） in beating heart through parastemal minimal invasive incision by partly cardiopulmonary bypass. Methods From October 2007 to March 2012,80 patients with mitral valve replacement were divided into study group （A group, n = 40） and control group （B group, n =40）. A group was by parastemal minimal invasive incision（6 -8 cm） and cardiopulmonary by- pass establishment through right femoral artery and vein cannulation;B group was by right lateral chest routhly incision （12- 18 cm） and cardiopulmonary bypass through aortic, superior vena cava and inferior vena cava cannulation. Both group underwent MVR in beating-heart. Results Incision length： A group was （6.7 ± 0. 61 ） cm, B group was （ 16. 51 ± 1.52）cm（P 〈0. 05） ; Operation time：A group was （74 ± 12. 00） min,B group was （71 ± 11.00） min（P 〉 0. 05 ） ; Bypass time ：A goup was （58 ± 13.30） min, B group was （56 ± 11.60） min（ P 〉 0. 05 ） ; Bleeding： A group was （183 ±56）ml,B group was （196 ±43）ml（P 〉0. 05） ;ICU time：A group was （36 ±8.5）h,B group was （37 ± 7.8 ） h（ P 〉 0.05 ） ; Postoperative hospital-stay time ： A group was （ 12 ± 2. 3 ） d, B group was （ 13 ± 2. 9 ） d （ P 〉 0. 05 ）. There were no incision infection, gas embolism, neurological complication. And there wrc no vessel damage a- bout aortic, femoral artery and vein cannulation. Conclusion Mitral valve replacement （NVR） in beating heart through parasternal minimal invasive incision by partly eardiopulmonary bypass can reduce incision length, minimize the surgical injury,relieve pain. It can bring fast recovery and attractive looks. And it provide a minimally-invasive technique and can be popularized easily.