微创体外循环和常规体外循环下行二尖瓣手术的对比研究

目的:探讨微创体外循环(minimal extracorporeal circulation,MECC)心内直视二尖瓣手术的疗效?方法:90例二尖瓣病变需行二尖瓣置换(MVR)或二尖瓣成型(MVP)手术的患者随机分成两组?MECC组(A组)45例,手术采用右胸前外侧小切口,经股动脉?股静脉和上腔静脉插管,建立MECC,术中应用负压辅助静脉引流装置;常规组(B组)45例,采用正中纵劈胸骨,经升主动脉,上?下腔静脉插管建立体外循环?观察并记录两组体外循环(CPB)时间(min),主动脉阻断时间(min),术中出血量(ml),输血量(ml),尿量(ml),24 h胸腔引流量(ml),术后辅助呼吸时间(h),ICU停留时间(h),住院总费用(万元)和手术后并发症发生情况?结果:两组均无手术死亡?A组CPB时间?主动脉阻断时间明显长于B组(P < 0.05);但A组术中失血量?围手术期输血量均明显少于B组(P < 0.01);手术后24小时总引流量A组显著较B组少(P < 0.01);A组术后呼吸机辅助时间?ICU停留时间均明显短于B组(P < 0.01),A组住院期间的总费用也少于B组(P < 0.01)?结论:MECC辅助下的MVR虽然增加了CPB时间?主动脉阻断时间,但创伤小?出血少?恢复快,切口美观,费用低,安全可靠,可能是未来心脏手术的发展趋势?

Minimal invasive mitral surgery under minimal extracorporeal circulation comparative study

Objective:To compare the outcomes of minimal invasive mitral surgery under minimal extracorporeal circulation with those under conventional middle sternotomy. Methods:Ninety patients with mitral stenosis and/or insufficiency,who need mitral repair or replacement,were randomized into minimal invasive (Group A,45 cases,minimal right thoracotomy under minimal extracorporeal circulation,MECC) or conventional middle sternotomy (Group B,45 cases). The following items are recorded and then compared:cardiopulmonary bypass time,aortic cross clamp time,the amount of blood lose during surgery,blood transfusion,peri-operative chest drainage,time of intubation and ICU stay post-operation. Results:There were no major complications and operative death in both groups. Both CPB time and cross clamp time in group A were longer then in Group B (P < 0.05). But the bloods lose during surgery,the amount of chest drainage and blood transfusion peri-operatively were significantly lower in Group A than in Group B (P < 0.05,P < 0.01,P < 0.05,respectively). The intubation time and ICU stay after surgery were obviously shorter in group A than in group B (P < 0.05),with lower hospital cost in group A. (P < 0.01). Conclusion:Mitral surgery through mini-thoracotomy under MECC improves the quality of surgery on following aspects:trauma,lower blood lose and transfusion,recovery,cost-effective,cosmetic effect and patients satisfaction even with relative longer CPB and cross clamp times.