胸腔镜辅助小切口与胸骨正中切口二尖瓣手术的对比研究：倾向性评分匹配研究
发布时间：2018-08-26 18:30
【摘要】：目的:微创二尖瓣手术在全球各大心脏外科中心已经常规开展,并取得了很好的手术效果。然而目前对于小切口二尖瓣手术的各项临床研究,结果仍不尽相同。本研究总结了本中心胸腔镜辅助下的右胸小切口二尖瓣手术经验,通过倾向性评分匹配,将小切口和传统正中切口二尖瓣手术进行对比。方法:本研究是一个单中心的回顾性队列研究。2014年1月至2016年12月,在本中心共有49例患者行小切口二尖瓣成形术和54例患者行小切口二尖瓣置换术。在同期行正中切口二尖瓣成形和二尖瓣置换的患者中通过倾向性评分匹配,1:1选出47例二尖瓣成形和54例二尖瓣置换作为对照组,与小切口组对比分析研究。结果:1、二尖瓣成形术:两组患者均无死亡病例,其中小切口组有2例(4.3%)出现术后并发症与正中切口组4例(8.5%)无明显差异。小切口组的平均体外循环时间和主动脉阻断时间显著长于正中切口组(108.7±29.4min vs.76.5±20.3min,p0.001;70.0±21.4min vs.49.6±17.1min,p0.001)。但是小切口组的平均术中出血量及术后引流量明显较正中切口组少(144±82.9ml vs.238±72.4ml,p0.001;469.6±443.5mlvs.676.5±377.6ml,p=0.017)。同样,小切口组患者的中位住院时间较正中切口组显著低(7d vs.9d,p0.001)。2、二尖瓣置换术:两组患者均无死亡病例,其中小切口组有7例(13%)出现术后并发症与正中切口组5例(9.3%)无显著差异。小切口组的平均手术时间、体外循环时间及主动脉阻断时间较正中切口组显著延长(188.7±43.0minvs.161.8±40.2min,p=0.001;104.7±-32.7min vs.73.8±15.5min,p0.001;66.9±25.6min vs.46.0±14.6min,p0.001)。然而小切口组患者的平均气管插管时间(18.2±6.Oh)明显低于正中切口组(24.5±14.1h),有统计学意义。同样,小切口组的平均术中出血量和平均术后引流量比正中切口组明显减少(141.7±98.9ml vs.240.7±71.4ml,p0.001;519.9±349.3ml vs.673.7±389.2ml,p=0.033)。类似的,小切口组患者的中位住院时间较正中切口组显著低(7.5d vs.8.5d,p=0.004)。3、疼痛评估:对所有患者出院前进行疼痛等级评分发现,小切口组患者手术伤口无痛的比例显著高于正中切口组(62.4%vs.36.6%,p0.001),而小切口组患者伤口轻度疼痛的比例明显低于正中切口组(33.7 vs.57.4%,p0.001)。4、学习曲线:2016年小切口二尖瓣手术的手术时间和术中出血量较2014年显著降低(181.9±47.0min vs.207.1±41.9min,P0.05;123.8±79.6ml vs.211.7±108.3ml,p0.05)。结论:胸腔镜辅助右胸小切口心脏二尖瓣手术是安全有效的,虽然较正中切口会延长体外循环及主动脉阻断时间,但是其可明显降低术中出血及术后引流量,缩短患者术后的住院时间,且具有良好的美容效果,患者术后疼痛少、恢复快,值得推广。
[Abstract]:Objective: Minimally invasive mitral valve surgery has been routinely performed in major cardiac surgery centers around the world and has achieved good results. However, the results of various clinical studies on minimally invasive mitral valve surgery are still different. Methods: This study was a single center retrospective cohort study. From January 2014 to December 2016, 49 patients underwent mini-incision mitral valvuloplasty and 54 patients underwent mini-incision mitral valve replacement in our center. Mitral valvuloplasty and mitral valve replacement were matched by propensity score. 47 cases of mitral valvuloplasty and 54 cases of mitral valve replacement were selected as control group. Results: 1. Mitral valvuloplasty: There were no deaths in both groups, of which 2 cases (4.3%) had postoperative complications compared with the median incision group (4.3%). The mean cardiopulmonary bypass time and aortic occlusion time in the small incision group were significantly longer than those in the median incision group (108.7 65507 Similarly, the median hospitalization time in the small incision group was significantly lower than that in the median incision group (7 days vs. 9 days, P 0.001). Mitral valve replacement: There were no deaths in both groups, of which 7 (13%) had postoperative complications and 5 (9.3%) had no significant difference between the small incision group and the median incision group. The mean operative time, cardiopulmonary bypass time and aortic occlusion time in the incision group were significantly longer than those in the median incision group (188.7 (+ 43.0) min vs. 161.8 (+ 40.2) min, P = 0.001; 104.7 (- 32.7) min vs. 73.8 (+ 15.5) min, P 0.001; 66.9 (+ 25.6) min vs. 46.0 (+ 14.6) min, P 0.001). However, the mean tracheal intubation time in the small incision group was significantly shorter than that in the median incision group (18.2 (+ 6. Similarly, the mean intraoperative bleeding volume and average postoperative drainage volume in the small incision group were significantly less than those in the median incision group (141.7 Pain Assessment: Pain rating scores for all patients before discharge showed that the proportion of painless wounds in the small incision group was significantly higher than that in the median incision group (62.4% vs. 36.6%, p0.001), while the proportion of mild pain in the small incision group was significantly lower than that in the median incision group (33.7 vs. 57.4%, p0.001). Curve: In 2016, the operation time and intraoperative bleeding volume of mini-thoracotomy mitral valve surgery were significantly shorter than those in 2014 (181.9 (+ 47.0) min vs. 207.1 (+ 41.9) min, P 0.05; 123.8 (+ 79.6) ml vs. 211.7 (+ 108.3) ml, P 0.05). Conclusion: Thoracoscopic-assisted right mini-thoracotomy mitral valve surgery is safe and effective, although it may prolong cardiopulmonary bypass and main thoracotomy mitral valve surgery compared Arterial occlusion time, but it can significantly reduce intraoperative bleeding and postoperative drainage, shorten postoperative hospital stay, and has a good cosmetic effect, less postoperative pain, fast recovery, worthy of promotion.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R654.2
本文编号：2205788
[Abstract]:Objective: Minimally invasive mitral valve surgery has been routinely performed in major cardiac surgery centers around the world and has achieved good results. However, the results of various clinical studies on minimally invasive mitral valve surgery are still different. Methods: This study was a single center retrospective cohort study. From January 2014 to December 2016, 49 patients underwent mini-incision mitral valvuloplasty and 54 patients underwent mini-incision mitral valve replacement in our center. Mitral valvuloplasty and mitral valve replacement were matched by propensity score. 47 cases of mitral valvuloplasty and 54 cases of mitral valve replacement were selected as control group. Results: 1. Mitral valvuloplasty: There were no deaths in both groups, of which 2 cases (4.3%) had postoperative complications compared with the median incision group (4.3%). The mean cardiopulmonary bypass time and aortic occlusion time in the small incision group were significantly longer than those in the median incision group (108.7 65507 Similarly, the median hospitalization time in the small incision group was significantly lower than that in the median incision group (7 days vs. 9 days, P 0.001). Mitral valve replacement: There were no deaths in both groups, of which 7 (13%) had postoperative complications and 5 (9.3%) had no significant difference between the small incision group and the median incision group. The mean operative time, cardiopulmonary bypass time and aortic occlusion time in the incision group were significantly longer than those in the median incision group (188.7 (+ 43.0) min vs. 161.8 (+ 40.2) min, P = 0.001; 104.7 (- 32.7) min vs. 73.8 (+ 15.5) min, P 0.001; 66.9 (+ 25.6) min vs. 46.0 (+ 14.6) min, P 0.001). However, the mean tracheal intubation time in the small incision group was significantly shorter than that in the median incision group (18.2 (+ 6. Similarly, the mean intraoperative bleeding volume and average postoperative drainage volume in the small incision group were significantly less than those in the median incision group (141.7 Pain Assessment: Pain rating scores for all patients before discharge showed that the proportion of painless wounds in the small incision group was significantly higher than that in the median incision group (62.4% vs. 36.6%, p0.001), while the proportion of mild pain in the small incision group was significantly lower than that in the median incision group (33.7 vs. 57.4%, p0.001). Curve: In 2016, the operation time and intraoperative bleeding volume of mini-thoracotomy mitral valve surgery were significantly shorter than those in 2014 (181.9 (+ 47.0) min vs. 207.1 (+ 41.9) min, P 0.05; 123.8 (+ 79.6) ml vs. 211.7 (+ 108.3) ml, P 0.05). Conclusion: Thoracoscopic-assisted right mini-thoracotomy mitral valve surgery is safe and effective, although it may prolong cardiopulmonary bypass and main thoracotomy mitral valve surgery compared Arterial occlusion time, but it can significantly reduce intraoperative bleeding and postoperative drainage, shorten postoperative hospital stay, and has a good cosmetic effect, less postoperative pain, fast recovery, worthy of promotion.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R654.2
【参考文献】
相关期刊论文 前1条
1 程实;谷天祥;修宗谊;吴立民;高锐;高雅;;真空辅助静脉引流技术在微创心脏手术中的应用[J];中国医疗器械杂志;2011年06期
，本文编号：2205788
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