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微創心臟瓣膜手術16例治療體會
Clinical study of 16 cases of minimally invasive heart valve surgery
摘要
目的：總結微創心臟瓣膜手術的臨床經驗。方法：選擇2013年5月～2015年5月收治的16例在體外循環下實施的胸腔鏡輔助或直視微創瓣膜手術。其中主動脈瓣置換術5例，二尖瓣成形術5例，二尖瓣置換術4例，二尖瓣＋主動脈瓣置換術2例，MVP＋MVR組7例中合併中度以上三尖瓣返流，均同期行三尖瓣成形術。5例合併房顫，均同期行房顫冷凍消融術。結果：院內死亡1例。中轉開胸2例。平均手術時間、體外循環時間、主動脈阻斷時間分別為320.0±97.8min、190.4±75.6min、124.7±97.8min，術後平均ICU時間和住院時間分別為4.9±2.7d和37.8±21.5d;術後24h內平均引流量為873.4±646.7ml。結論：微創瓣膜手術安全有效、創傷小、恢復快。與傳統手術相比不增加手術死亡率和併發症的發生率，能縮短ICU時間和術後住院時間。
並列摘要
Objective: To review our clinical experience in minimally invasive cardiac valve surgery. Methods: 16 cases with minimally invasive cardiac valve surgery in our hospital from May 2013 to May 2015 were reviewed , There were 5 cases of aortic valve replacement(AVR), 5 cases of mitral valve repair( MVP), 4 cases of mitral valve replacement (MVR) and 2 cases of mitral and aortic valve replacement(DVR). Seven cases of MVP or MVR also had tricuspid regurgitation (moderated to severe), so tricuspid valve repair(TVP) was performed as well. Five cases had atrial fibrillation(AF), cryo-ablation of AF were performed. Results: There was one operative death. 2 cases needed conversion to median sternotomy. Mean operation, cardiopulmonary bypass and aortic clamp time were 320.4 ± 97.8min, 190.4 ± 75.6min and 124.7 ± 97.8min respectively. Mean length of intensive care unit (ICU) and hospital stay were 4.9 ± 2.7d and 37.8 ± 21.5d. Mean volume of drainage were 873. 4 ± 646.7ml. Conclusion: MIVS though minimally invasive access is safe and feasible, with good cosmetic results and rapid postoperative recovery. Comparing with the traditional surgery, MIVS did not increase surgical mortality and the complication rate, with shorten length of ICU and hospital stay. In conclusion, for patients with disease who meet indication for surgery, MIVS is a good choice.