CAJ | 학술논문

目的回顾性分析直视微创手术与传统正中开胸二尖瓣置换手术患者资料,探讨直视微创手术的优势.方法 2009年2月至2012年12月,141例患者行单纯二尖瓣置换手术,其中直视微创手术69例,传统正中开胸手术72例；置换机械瓣膜90例,生物瓣膜51例.直视微创心脏外科手术方法为股动、静脉及右颈静脉插管行体外循环,双腔气管插管.经右侧胸骨第4肋间入路,左侧肺单侧呼吸情况下,以Chitwood钳经胸阻断升主动脉,升主动脉根部灌注心脏停搏液,心脏停搏后经右房间沟入路行二尖瓣置换手术.同期传统正中开胸患者行上、下腔静脉插管,右房间沟或右房房间隔人路行二尖瓣置换手术.结果直视微创手术与传统正中开胸二尖瓣置换手术的手术、体外循环、主动脉阻断和住重症监护室(ICU)时间差异无统计学意义,手术后住院时间、术后引流量、围术期输血量和手术切口长度等差异显著.结论在跨越了学习曲线后,直视心脏外科二尖瓣手术比传统正中开胸手术有诸多优势,安全、有效.
목적 회고성분석직시미창수술여전통정중개흉이첨판치환수술환자자료,탐토직시미창수술적우세.방법 2009년2월지2012년12월,141례환자행단순이첨판치환수술,기중직시미창수술69례,전통정중개흉수술72례；치환궤계판막90례,생물판막51례.직시미창심장외과수술방법위고동、정맥급우경정맥삽관행체외순배,쌍강기관삽관.경우측흉골제4륵간입로,좌측폐단측호흡정황하,이Chitwood겸경흉조단승주동맥,승주동맥근부관주심장정박액,심장정박후경우방간구입로행이첨판치환수술.동기전통정중개흉환자행상、하강정맥삽관,우방간구혹우방방간격인로행이첨판치환수술.결과 직시미창수술여전통정중개흉이첨판치환수술적수술、체외순배、주동맥조단화주중증감호실(ICU)시간차이무통계학의의,수술후주원시간、술후인류량、위술기수혈량화수술절구장도등차이현저.결론 재과월료학습곡선후,직시심장외과이첨판수술비전통정중개흉수술유제다우세,안전、유효.
Objective Discuss the different between minimally invasive and conventional thoracotomy mitral valve replacement surgery.Methods Select 141 cases from February 2009 to December 2012 in our hospital suffer mitral valve replacement surgery.69 cases minimally invasive surgery and the 72 cases conventional thoracotomy mitral valve replacement surgery,mechanical valve 90 cases,the bioprosthesis 51 cases.The establishment of cardiopulmonary bypass is through the femoral artery and vein and the right jugular vein with cannulation.Under the guide of transesophageal echocardiography (TEE) and adjust the the intubation position to the inferior vena cava and superior vena cava junction.Double-lumen endotracheal intubation in trachea.Transthoracic approach through the right side of the stemum 4 intercostal,the left lung unilateral breathing and fight lung collapse.Open the pericardium with minimally invasive surgical instruments away 2 cm from the phrenic nerve.Transthoracic chitwood clamp blocking the ascending aorta,HTK or crystalloid cardioplegia aortic root perfusion.Arrest heart minimally invasive mitral valve replacement surgery.After CPB,unplug the femoral artery and vein catheter,6-0 prolene suture femoral artery reconstruction pathway.Results Minimally invasive compared to the conventional median thoracotomy mitral valve replacement surgery have no significant difference in operative time,cardiopulmonary bypass time,aortic clamping timeand the intensive care unit (ICU) time.Conclusion Overcome the learning curve,minimally invasive mitral valve surgery have many advantages than the conventional median thoracotomy surgery is a safe,effective,and easy to spread surgery.