右胸小切口与正中切口在心脏二次手术中的对比

The Comparation of Right Minithoracotomy and Sternracotomy in the Heart Valve Reoperation

摘要: 目的：该文旨在比较总结右胸小切口在瓣膜二次置换、成形手术中的临床经验，讨论其实践意义。方法：对2017年1月至2019年6月我院心血管外科收治的50例二次手术患者进行回顾性分析。其中15例经右胸第4肋间切口，经股静动脉建立体外循环，35例经原正中切口，常规建立体外循环，术后评估手术效果并进行对比。结果：50例手术均成功，无围术期死亡。小切口组平均手术时间(230.7 ± 44.7) min、体外循环时间(107.4 ± 47.7) min、术后呼吸机使用时间(17.6 ± 15.5) h、术后第一天引流量(216.7 ± 120.3) ml、术后ICU停留时间(94.4 ± 67.9) h、平均住院时间(17.1 ± 3.1) d。其中手术时间、体外循环时间、术后第一天引流量较正中切口组有优势，术后呼吸机使用时间、术后ICU时间及术后住院时间无明显统计学差异。结论：右胸小切口在二次换瓣手术中安全可靠，值得应用。

Abstract: Objective: To compare and conclude the clinical experience used in minimally invasive valve replacement or valvoplasty. Methods: Form January 2017 to June 2019, 50 patients who had underwent an heart valve operation via median sternotomy were involved and underwent valve reoperation,15 of them through right anterolateral thoracotomy and the other through median sternotomy. The intraoperative and postoperative outcomes between two groups were compared and analyzed. Result: All the operations were successful. The mean operative time was (230.7 ± 44.7) min. The cardiopulmonary bypass time was (107.4 ± 47.7) min. The mean postoperative ventilation time was (17.6 ± 15.50) h. The mean first day chest tube drainage was (216.7 ± 120.3) ml. The mean length stay of ICU and hospital times were (94.4 ± 67.9) hour, (17.1 ± 3.1) day. The operative time, cardiopulmonary bypass time in minithoracotomy were shorter and mean first day chest tube drainage was fewer than the sternoracotomy group. There was no statistically significant difference between the two groups in the postoperative ventilation time, length of stay in ICU and hospital. Conclusion: The incision of right anterolateraI moracotomy in the forth intercostal space is safe and worthy of practice in clinic.