2020 年第 9 期 第 15 卷

完全胸腔镜微创手术与传统开胸手术治疗单纯二尖瓣疾病的近远期效果比较

Short-term and long-term effects of complete thoracoscopic minimally invasive surgery and traditional thoracotomy in patients with mitral valve disease

作者：陈飞周庆伍明肖国华侯安兴

英文作者：Chen Fei Zhou Qing Wu Ming Xiao Guohua Hou Anxing 

单位：湖南省人民医院湖南师范大学附属第一医院心胸外科，长沙410005

英文单位：Cardio-Thoracic Surgery the People′s Hospital of Hunan Province the First Affiliated Hospital of Hunan Normal University Changsha 410005 China

关键词：二尖瓣疾病；全胸腔镜微创手术；传统开胸手术；二尖瓣置换术

英文关键词：Mitraldisease;Totalthoracoscopicminimallyinvasivesurgery;Traditionalthoracotomy;Mitralvalvereplacement

• 摘要：

• 目的 探讨完全胸腔镜微创手术与传统开胸手术治疗单纯二尖瓣疾病（MVD）的近远期临床效果。方法 选取湖南师范大学附属第一医院2015年5月至2017年1月收治的单纯MVD患者120例，应用随机数字表法分为对照组与观察组，各60例。对照组采用传统开胸手术，观察组采用完全胸腔镜微创手术。比较2组患者术中和术后资料、术前和术后2周心脏彩色多普勒超声检查结果、院内病死率及术后并发症发生率以及术后1、3年病死率和纽约心脏病协会（NYHA）心功能分级。结果观察组患者体外循环时间、主动脉阻断时间长于对照组［(160±43)min比（121±37）min、(89±28)min比（56±16）min］，术中出血量少于对照组［(257±82)ml比（436±106）ml］，呼吸机辅助时间、术后重症监护病房停留时间和住院时间均短于对照组，术后24 h胸腔引流量、红细胞输血量均少于对照组（均P<0.05）。术后2周，2组患者左心室射血分数均高于术前，左心室舒张末期内径和左心房内径均低于术前（均P<0.05），但组间比较差异均无统计学意义（均P>0.05）。观察组术后肺部感染、脓毒血症、心律失常发生率均低于对照组［10.0%(6/60)比26.7%（16/60）、10.0%(6/60)比23.3%（14/60）、8.3%(5/60)比28.3%（17/60）］（均P<0.05）。观察组术后3年NYHA心功能分级优于对照组（P＜0.05），但2组患者术前、术后1年NYHA心功能分级以及术后1、3年病死率比较差异均无统计学意义（均P>0.05）。结论 完全胸腔镜微创手术与传统开胸手术治疗单纯MVD患者均具有较好的近期临床效果，但完全胸腔镜微创手术在手术创伤、术后恢复、术后肺部感染、心律失常等并发症方面更具优势，且远期预后更佳。

• Objective To explore the short-term and long-term clinical effects of complete thoracoscopic minimally invasive surgery and traditional thoracotomy in the treatment of stand-alone mitral valve disease (MVD). Methods From May 2015 to January 2017, 120 patients with simple MVD admitted to the First Affiliated Hospital of Hunan Normal University were selected. They were randomly divided into control group and observation group, with 60 cases in each group. The patients in the control group were treated with conventional thoracotomy and the patients in the observation group were treated with total thoracoscopic surgery. Operation data, the results of color Doppler echocardiography, in-hospital mortality, postoperative complications, the mortality of 1 and 3 years after the operation and the NYHA classification of cardiac function were compared between the two groups. Results The time of cardiopulmonary bypass and aortic occlusion in the observation group were longer than those in the control group ［(160±43)min vs (121±37)min, (89±28)min vs (56±16)min］; the amount of intraoperative bleeding was smaller than that in the control group ［(257±82)ml vs (436±106)ml］, the time of ventilator, ICU and hospitalization were shorter than those in the control group, the volume of blood flow and red blood cell transfusion were lower than those in the control group (all P＜0.05). At 2 weeks after operation, the left ventricular ejection fraction (LVEF) of the two groups were higher than those before operation; the left ventricular end diastolic diameter and left atrial diameter were lower than those before operation (all P＜0.05), but there were no significant differences between the two groups (P＞0.05). The incidences of postoperative pulmonary infection, sepsis and arrhythmia in observation group were lower than those in control group ［10.0%(6/60) vs 26.7%(16/60), 10.0%(6/60) vs 23.3%(14/60), 8.3%(5/60) vs 28.3%(17/60)］(all P＜0.05). Three years after operation, the NYHA cardiac function grade of the observation group was better than that of the control group(P<0.05). Conclusions Complete thoracoscopic minimally invasive surgery and traditional thoracotomy show good short-term clinical effect on MVD patients. Total thoracoscopic procedure shows high advantages in termsof surgical trauma, postoperative recovery, postoperative pulmonary infection, arrhythmia and safety; the long-term prognosis is good.