12例右胸骨旁第3肋间小切口行三瓣膜手术的临床经验

发布时间：2019-02-09 15:58

【摘要】：目的总结我院经右胸骨旁第3肋间小切口行三瓣膜手术的临床经验。方法 2013年6月至2014年3月12例患者接受手术治疗,其中男性8例,女性4例;年龄35~65岁,平均(48.3±9.1)岁。患者中包括:9例风湿性瓣膜病,累及二尖瓣及主动脉瓣,合并有继发性三尖瓣关闭不全;1例风湿性瓣膜病,累及二尖瓣、主动脉瓣及三尖瓣;2例主动脉瓣退行性病变致继发性二尖瓣、三尖瓣关闭不全。12例患者均在全身麻醉、双腔气管插管、体外循环辅助下手术,术式包括二尖瓣、主动脉瓣及三尖瓣置换术1例,二尖瓣、主动脉瓣置换及三尖瓣成形术9例,主动脉瓣置换、二尖瓣及三尖瓣成形术2例。结果无围术期死亡,无中转开胸手术,无再次开胸止血。6例患者输血,平均输血量为(408.3±444.4)mL。无主动脉夹层、肾功能不全及感染等并发症。术后随访3~9个月,平均(6.3±2.0)个月,无瓣周漏及严重心血管事件发生。结论经右胸骨旁第3肋间小切口行微创三瓣膜手术安全有效,可减少手术创伤,增加患者满意度,作为临床治疗的一种选择。
[Abstract]:Objective to summarize the clinical experience of triple valve operation through the third intercostal small incision of right sternum in our hospital. Methods from June 2013 to March 2014, 12 patients (8 males and 4 females) received surgical treatment, with an average age of (48.3 卤9.1) years (35 ~ 65 years). The patients included 9 cases of rheumatic valvular disease involving mitral valve and aortic valve with secondary tricuspid insufficiency, 1 case of rheumatic valve disease involving mitral valve, aortic valve and tricuspid valve, 1 case of rheumatic valvular disease involving mitral valve, aortic valve and tricuspid valve, and 1 case of rheumatic valve disease involving mitral valve, aortic valve and tricuspid valve. Two patients with secondary mitral valve and tricuspid valve insufficiency caused by aortic valve degenerative disease. 12 patients were under general anesthesia, double lumen tracheal intubation, cardiopulmonary bypass assisted operation, including mitral valve, aortic valve and tricuspid valve replacement in 1 case, the procedure included mitral valve, aortic valve and tricuspid valve replacement. Mitral valve, aortic valve replacement and tricuspid valvuloplasty in 9 cases, aortic valve replacement in 2 cases, mitral valve and tricuspid valve plasty in 2 cases. Results there was no perioperative death, no conversion to thoracotomy, no rethoracotomy and no hemostasis. The average blood transfusion volume was (408.3 卤444.4) mL. in 6 patients. There were no complications such as aortic dissection, renal insufficiency and infection. Follow-up for 3 to 9 months (mean 6.3 卤2.0 months) showed no perivalvular leakage and severe cardiovascular events. Conclusion minimally invasive triple valve surgery via the third intercostal small incision of right parasternal bone is safe and effective. It can reduce surgical trauma and increase patient satisfaction as a choice of clinical treatment.
【作者单位】：复旦大学附属中山医院心脏外科;上海市心血管病研究所;
【分类号】：R654.2

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