胸腔镜辅助下右胸小切口行二尖瓣成形术同期三尖瓣成形术的疗效及安全性研究

Therapeutic effect and safety of thoracoscopic-assisted mitral valvuloplasty and concurrent tricuspid valvuloplasty via small right thoracic incision

摘要:

目的 探讨胸腔镜辅助下右胸小切口行二尖瓣成形术（MVP）同期三尖瓣成形术（TVP）的疗效及安全性。方法 选取2017年1月—2020年5月天水市第一人民医院收治的退行性心脏瓣膜病患者82例作为研究对象。将患者分为对照组和研究组，各41例。研究组患者行胸腔镜辅助下右胸小切口MVP及同期TVP治疗，对照组患者行常规正中开胸MVP及同期TVP治疗，术后随访18个月。统计两组患者手术及术后恢复情况，记录术后疼痛情况，分析手术前后心功能情况，记录术后二尖瓣及三尖瓣残余反流情况，统计住院期间并发症发生情况及预后。结果 研究组患者主动脉阻断时间、体外循环时间、手术时间长于对照组（P <0.05）。研究组患者ICU停留时间、术后呼吸机使用时间短于对照组，胸腔引流量少于对照组（P <0.05）。两组患者术后6 h、12 h、24 h、48 h的静息状态下VAS评分比较，经重复测量设计的方差分析，结果 ①不同时间点的VAS评分有差异（P <0.05）；②两组患者静息状态下VAS评分有差异（P <0.05），研究组患者在静息状态下VAS评分较对照组低，相对镇痛效果较好；③两组患者VAS评分变化趋势有差异（P <0.05）。两组患者手术前后LVEF、LVEDD的差值比较，差异无统计学意义（P >0.05）。两组患者术后2周的二尖瓣及三尖瓣残余反流量比较，差异无统计学意义（P >0.05）。研究组患者总并发症发生率低于对照组（P <0.05）。两组患者总心脏不良事件发生率比较，差异无统计学意义（P >0.05）。结论 胸腔镜辅助下右胸小切口行MVP及同期TVP与常规正中开胸在退行性心脏瓣膜病中的疗效相近，该方案虽然手术时间延长，但是可加快患者术后恢复，疼痛轻，且安全性更高。

Abstract:

Objective To explore the therapeutic effect and safety of thoracoscopic-assisted mitral valvuloplasty (MVP) and concurrent tricuspid valvuloplasty (TVP) via small right thoracic incision.Methods A total of 82 patients with degenerative heart valvular disease admitted to our hospital from January 2017 to April 2020 were selected and divided into control and study groups, with 41 cases in each group. The study group underwent thoracoscopic-assisted MVP and concurrent TVP treatment via small right thoracic incision, while the control group underwent MVP and concurrent TVP treatment via median thoracotomy. The postoperative follow-up duration was 18 months. The operation and postoperative recovery of the two groups were observed. Postoperative pain in the two groups was recorded. The cardiac function of the two groups before and after the operation was analyzed. Postoperative mitral and tricuspid regurgitation in the two groups were recorded. The complications during hospitalization and short-term prognosis of the two groups were determined.Results The aortic cross-clamp time, cardiopulmonary bypass time, and operative duration in the study group were longer than those in the control group (P < 0.05). The length of intensive care unit (ICU) stay and duration of postoperative mechanical ventilation were shorter, and the volume of chest drainage was lower in the study group than those in the control group (P < 0.05). The Visual Analogue Scale (VAS) scores at rest were compared between the study group and the control group at 6 h, 12 h, 24 h, and 48 h after the operation. The VAS scores at rest were different at distinct time points (P < 0.05) and between the two groups (P < 0.05). The VAS scores at rest in the study group were lower than those in the control group (P < 0.05), indicating a better analgesic effect. The change trends of VAS scores at rest between the study group and the control group were different (P < 0.05). The differences of left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) before and after the operation were not significantly different between the two groups (P > 0.05). There was no significant difference in mitral and tricuspid regurgitation between the two groups at 2 weeks after the operation (P > 0.05). The overall incidence of complications in the study group was lower than that in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse cardiac events between the two groups (P > 0.05).Conclusions The therapeutic effect of thoracoscopic-assisted MVP and concurrent TVP via small right thoracic incision was comparable to that via median thoracotomy in degenerative heart valve disease. Although the operative duration of thoracoscopic-assisted MVP and concurrent TVP via small right thoracic incision is prolonged, it can enhance the postoperative recovery with less pain and fewer safety concerns.