目的 总结经胸骨上段小切口双瓣膜置换或成形术的临床经验。方法 5例主动脉瓣、二尖瓣联合瓣膜病患者采用胸骨上段小切口,全麻单腔气管插管、股动静脉及上腔静脉插管心肺转流下行主动脉置换、二尖瓣置换或成形术。结果 全组无死亡病例,无切口延长病例,无二次开胸止血及气管插管,手术时间较常规手术延长、体外循环时间、主动脉阻断时间、术后机械通气时间,引流量、输血量,ICU时间无差异与常规手术相似,术后随访3个月、6个月、1年,瓣膜功能良好,切口疤痕无明显增生。结论 经胸骨上段小切口行双瓣膜手术是安全可行的,与传统手术相比能获得相似的治疗效果,近期随访疗效可靠。
Objective To summarize the clinical experience of minimally invasive double valve replacement or repair via partial upper hemisternotomy.Methods Five patients with combined aortic valve and mitral valve disease underwent aortic replacement,mitral valve replacement,or repair via partial upper hemisternotomy with cardiopulmonary bypass through femoral artery,femoral vein,and superior vena cava cannulation,under general anesthesia with single lumen endotracheal intubation.Results There were no death cases,prolonged incision,second thoracotomy hemostasis,or tracheal intubation.The operation time was longer than routine operation; cardiopulmonary bypass time,aortic clump time,postoperative mechanical ventilation time,drainage,blood transfusion volume,and ICU time by designed operation were similar to those by routine operation.At 3-month,6-month,and 1-year follow-ups,the valves were with good function and there was no obvious proliferation of incision scar.Conclusion It is safe and feasible to perform double valve surgery via partial upper hemisternotomy.Compared with traditional operation,it can obtain similar therapeutic effect,and the short-term follow-up effect is reliable.
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