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目的 比较微创全胸腔镜与传统正中开胸二尖瓣置换手术治疗的手术结果及远期随访差异.方法 收集2012年1月至2015年6月行二尖瓣置换手术患者1 096例(微创组胸腔镜405例,正中开胸组691例),利用倾向性评分匹配的方法,入组404例病患(微创胸腔镜组202例,正中开胸组202例).收集比较匹配后的两组患者的术中及术后资料,随访及SF-36量表评估其生活质量.结果 微创组比正中开胸组在体外循环时间[(145.97±34.65) min对(92.24±25.58) min,(P＜0.001)]、主动脉阻断时间[(93.89±25.25) min对(56.42±18.09) min,(P＜0.001)]、手术时间[(237.49 ±47.48)min对(217.31 ±55.95) min,(P＜0.001)]等方面时间长,差异有统计学意义.而微创组输血比例少(24.26％对33.66％,P=0.037)、机械通气时间短[(15.29±11.45)h对(21.34 ±40.36)h,(P=0.041)]、ICU停留时间短[(44.12 ±39.51)h对(61.15±106.01)h,(P=0.033)]、胸腔引流量少[(404.11±485.84)ml对(674.82±585.37) ml,(P＜0.001)]、保留胸腔引流管时间短[(2.59±1.75)天对(4.25±1.91)天,(P＜0.001)]、术后住院时间短[(5.64 ±3.07)天对(11.44±6.71)天,(P＜0.001)],差异有统计学意义.随访并发症及SF-36量表差异无统计学意义(P＞0.05).结论 微创胸腔镜下行二尖瓣置换术虽然增加了体外循环时间及阻断时间,但手术死亡率及并发症没有额外增加,具有明显创伤小、输血少、切口感染少、恢复快、美容等优势.胸腔镜心脏外科手术是安全、有效、可行的术式.

Objective To compare the surgical outcome and long-term follow-up after mitral valve replacement through either minimally invasive(MI) or traditional median stemotomy(ST) surgery.Methods All 1 096 patients who received either MI or ST mitral valve replacement surgery,between January 1,2012 and July 30,2015 were analyzed for outcome differences due to surgical approach using propensity score matching(MI group n =405,ST group n =691).Find out the best matched with the 202 cases of the two groups.The clinical data of patients were collected including operativedata,postoperativecomplications,and follow-up.Results MI Group was longer in CPB time [(145.97 ±34.65)min vs.(92.24 ±25.58)min,(P ＜ 0.001)],aortic clamping time [(93.89 ± 25.25) min vs.(56.42 ± 18.09) min,(P ＜ 0.001)],and operating time[(237.49 ± 47.48) min vs.(217.31 ± 55.95) min,(P ＜ 0.001)].The MI group was associated with more less in transfusion(24.26％ vs 33.66％ P=0.037),mechanical ventilation[(15.29 ±11.45)h vs.(21.34 ±40.36)h,(P=0.041)],ICU stay[(44.12 ±39.51)h vs.(61.15 ± 106.01) h,(P =0.033)],volume of thoracic drainag[(404.11 ±485.84)ml vs.(674.82 ±585.37)ml,(P＜0.001)],postoperative drainage time[(2.59 ±1.75)d vs.(4.25 ±1.91)d,(P ＜0.001)],hospital stay [(5.64 ± 3.07) d vs.(1 1.44 ± 6.71) d,(P ＜ 0.001)].There were no significant difference in the complications of follow-up(P ＞ 0.05).SF-36 score had no significant difference either(P ＞ 0.05).Conclusion The minimally invasive thoracoseopic has longer in CBP time and cross-clamp time,;but it didnot increase the risk of mortality and complications.What's more,havingless trauma,fewer transfusions,lcss wound infection,faster rccovcry,and high satisfaction with the incision in long-term follow up and other advantages.Minimally invasive thoracoscopic cardiac surgery is safe,effective and feasible.