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三种入路行二尖瓣后叶成形手术近中期疗效比较

Repair of posterior mitral valve prolapsed: comparative study of three different approaches

摘要:

目的 对三种手术入路行二尖瓣后叶成形术的近中期手术效果进行比较.方法2010年8月至2011年7月前瞻性人组70例单纯二尖瓣后叶病变患者,男性49例,女性21例,年龄16~70岁,平均53.4岁.根据手术方法分为胸骨正中切口组(标准组)30例、右胸前外侧切口组(微创组)30例、da Vinci机器人组(da Vinci组)10例,对比分析三组患者的临床资料.结果 全组无院内死亡.与微创组和标准组相比,da Vinci组的手术时间[(300±41)min、(184±20) min和(169±22) min,F=112.5,P<0.01]、心肺转流时间[(139±26)min、(82±20)min和(69±23)min,F=36.8,P<0.01]、主动脉阻断时间[(93±23) min、(47±10) min和(38±8)min,F=75.0,P<0.01]均延长,机械通气时间[(4.9±2.1)h、(5.3±4.5)h和(14.1±10.2)h,F=13.2,P<0.01]、ICU时间[(15.1±2.1)h、(16.4±5.4)h和(28.7±16.1)h,F=11.6,P<0.01]、术后住院时间[(4.6±1.0)d、(5.7±1.7)d和(8.8±5.1)d,F=8.0,P<0.01]缩短,术后胸腔引流量[(192±200) ml、(215±163)nl和(405±239)ml,F=7.1,P<0.01]和输血患者的比例(0、20.0%和66.7%,x2 =22.7,P<0.01)减少.患者随访6~17个月,随访率100%,随访期间无患者死亡,无中度及以上二尖瓣反流,da Vinci 组患者较微创组和标准组患者恢复至正常活动状态时间更短[(2.4±0.7)周、(4.2±1.2)周和(8.2±1.8)周,F=83.0,P<0.01].结论 本研究表明经右胸前外侧切口和da Vinci机器人辅助二尖瓣后叶成形手术安全、有效,减少了引流量和输血患者的比例,缩短了术后住院时间和恢复时间,值得在临床选择性应用.

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abstracts:

Objective To compared outcomes of robotic mitral valve repair with those of standard sternotomy,and right anterolateral thoracotomy.Method From August 2010 to July 2011,70 patients with degenerative mitral valve disease and posterior leaflet prolapsed scheduled for elective isolated mitral valve repair were prospectively unrandomized to undergo mitral valve operation by standard sternotomy ( n =30),right anterolateral thoracotomy( n =30),or a robotic approach ( n =10).There were 49 male and 21 female patients,aging from 16 to 70 years with a mean of 53.4 years.Outcomes of the three groups were compared.Results Mitral valve repair was achieved in all patients except 1 patient in the standard group.There were no in-hospital deaths.The median operation time [ (300 ±41 ) min,( 184 ±20) min and ( 169 ±22) min,F =112.5,P < 0.01 ],cardiopulmonary bypass time [ ( 139 ± 26 ) min,( 82 ± 20 ) min and ( 69 ± 23 )min,F=36.8,P <0.01 ],aortic cross-clamping time [ (93±23) min,(47 ± 10) min and (38 ±8) min,F =75.0,P <0.01 ]were longer for robotic than standard stemotomy and right anterolateral thoracotomy.The robotic group had shortest time of mechanical ventilation time [ (4.9 ± 2.1 ) h,( 5.3 ± 4.5 ) h and ( 14.1 ± 10.2) h,F =13.2,P < 0.01 ],ICU time [ ( 15.1 ± 2.1 ) h,( 16.4 ± 5.4 ) h and ( 28 7 ±16.1 ) h,F =11.6,P < 0.01 ],postoperative hospital stay time [ ( 4.6 ± 1.0 ) d,( 5.7 ± 1.7 ) d and (8.8±5.1) d,F=8.0,P<0.01 ]with the lowest of drainage [( 192±200) ml,(215 ± 163) ml and (405 ± 239) ml,F =7.1,P < 0.01 ]and ratio of the patients needed blood transfusion ( 0,20.0% and 66.7%,x2 =22.7,P <0.01 ).Patients were followed up 6 to 17 months,with 100% completed.No patients died during follow-ups,and no moderate or more mitral regurgitation was observed.The robotic group had the shortest time of return to normal activities compared with the other two groups [ ( 2.4 ±0.7 )weeks,(4.2±1.2) weeks and (8.2±18) weeks,F=83.0,P<0.01 ].Conclusion This study shows mitral valve repair via the right anterolateral thoracotomy and a robotic approach is safe and feasible,with good cosmetic results and rapid postoperative recovery,and is worthy of clinical selective application.

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作者: 魏来 [1] 沈金强 [1] 王春生 [1] 夏利民 [1] 杨兆华 [1] 刘欢 [1] 朱家驷 [1] 罗红 [2] 郭克芳 [2] 胡克俭 [1]
第一作者: 魏来
期刊: 《中华外科杂志》2012年50卷7期 637-641页 MEDLINEISTICPKUCSCD
分类号: R654.2
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2012.07.017
发布时间: 2012-10-29
基金项目:
上海市科委医学引导类项目 上海市卫生行业科研专项资助项目
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