右胸微创小切口与传统胸部正中切口左心房粘液瘤摘除术的疗效对比研究

发布时间：2018-06-06 04:39

本文选题：微创手术 + 正中切口手术　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:对比右胸微创小切口与传统胸部正中切口行左心房粘液瘤摘除术的安全性及临床疗效。材料及方法:选择2011年07月至2017年02月吉林大学第二医院心血管外科施行右胸微创小切口左心房粘液瘤摘除术39例患者作为小切口组,同期收治的30例行传统胸部正中切口的左心房粘液瘤患者作为对照组。小切口组共有39例左心房粘液瘤患者,均根据病史、专科查体、心脏超声心动图等检查确诊为左心房粘液瘤疾病,其中单纯左心房粘液瘤17例,合并二尖瓣返流6例,合并三尖瓣返流6例,合并二尖瓣及三尖瓣返流10例。对照组中单纯左心房粘液瘤14例,合并二尖瓣返流5例,合并三尖瓣返流4例,合并二尖瓣及三尖瓣返流7例。收集并比较两组患者的院内死亡率,主动脉阻断时间、转机时间、手术时间、术后机械通气时间、ICU停留时间、术后24h引流量、二次开胸止血率、术后输血量、下地活动时间、住院时间以及术后并发症发生率,以及术后6个月、1年、3年行门诊和/或电话随访结果。运用SPSS 19.0软件进行统计学处理,计量资料以(?)表示,两组之间采用独立样本t检验比较;计数资料以例数(%)表示,两组之间采用X~2检验比较。P0.05为差异有统计学意义。结果:所有患者均顺利完成手术,术中摘除物病理检查结果均证实为粘液瘤,两组围术期均无死亡病例。小切口组患者,切口长度(4-6)cm,平均(5.2±1.2)cm。小切口组主动脉阻断时间、转机时间以及手术时间长于对照组(P0.05),而术后机械通气时间、ICU停留时间、术后24h引流量、二次开胸止血率、术后输血量、下地活动时间、住院时间较对照组均有统计学意义的缩短或减少(P0.05)。小切口组以及对照组术后均无肾功能衰竭、其他重要脏器衰竭、神经系统等并发症。小切口组有1例发生切口脂肪液化,经换药后愈合,而对照组有1例发生纵隔感染,经清创缝合后愈合。两组患者术后6个月、1年、3年行随访,随访期间,两组均无死亡、无复发,心功能均明显好转。结论:采用右胸微创小切口行左心房粘液瘤摘除术安全可行,疗效确切,且具有明显的优越性,值得推广。
[Abstract]:Objective: to compare the safety and clinical effect of left atrial myxoma resection with right thoracic minimally invasive incision and traditional median thoracotomy. Materials and methods: from July 2011 to February 2017, 39 patients with left atrial myxoma underwent minimally invasive left atrial myxoma resection in the second Hospital of Jilin University were selected as the small incision group. Thirty patients with left atrial myxoma treated with traditional median thoracotomy were treated as control group. In the small incision group, 39 patients with left atrial myxoma were diagnosed as left atrial myxoma according to their history, physical examination and echocardiography, including 17 cases of left atrial myxoma and 6 cases of mitral regurgitation. There were 6 cases with tricuspid regurgitation and 10 cases with mitral and tricuspid regurgitation. In the control group, 14 cases of left atrial myxoma, 5 cases of mitral regurgitation, 4 cases of tricuspid regurgitation, 7 cases of mitral and tricuspid regurgitation were found. The hospital mortality, aortic clamping time, transit time, operation time, postoperative mechanical ventilation time and ICU stay time, postoperative 24 h drainage flow, rethoracotomy hemostasis rate, postoperative blood transfusion volume, subsurface activity time were collected and compared between the two groups. The duration of hospitalization, the incidence of postoperative complications, and the results of outpatient and / or telephone follow-up at 6 months, 1 year and 3 years after operation. Use SPSS 19.0 software to carry on the statistics processing, the metrological data is used to be accurate) The results showed that the two groups were compared by independent sample t-test, and the counting data were expressed by examples. The difference between the two groups was statistically significant by using Xan2 test. P05 was the difference between the two groups. Results: all the patients completed the operation successfully, and the pathological examination of extirpation proved myxoma, and there were no death cases in both groups during perioperative period. In the small incision group, the incision length was 4-6 cm (mean 5.2 卤1.2 cm). The aortic clamping time, transit time and operation time in the small incision group were longer than those in the control group (P 0.05), but the mechanical ventilation time after operation was longer than that in the control group, and the duration of mechanical ventilation was the time of staying in ICU, the drainage flow at 24 hours after operation, the hemostasis rate of second thoracotomy, the amount of blood transfusion after operation, and the time of ground movement. Compared with the control group, the hospitalization time was significantly shortened or decreased (P 0.05). There were no renal failure, other important organ failure and nervous system complications in small incision group and control group. In the small incision group, 1 case had incision fat liquefaction and healed after dressing change, while in the control group, 1 case had mediastinal infection and healed after debridement and suture. The patients in both groups were followed up for 6 months, 1 year and 3 years after operation. During the follow-up period, there was no death, no recurrence and significant improvement of cardiac function in both groups. Conclusion: the right thoracic minimally invasive small incision for left atrial myxoma excision is safe and effective, and has obvious advantages, which is worth popularizing.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R732.1

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