饶健 尤颢 孙勇 牛田 宋世波 胡珀元

【摘要】 目的：评价40例胸腔镜辅助下二尖瓣手术的技术特点、安全性及应用价值。方法：2015年6月-2017年12月在厦门大学附属心血管病医院心外科接受胸腔镜二尖瓣手术治疗的40例患者。根据二尖瓣病变类型分为风湿性二尖瓣病变12例，二尖瓣退行病变24例，感染性心内膜炎4例，合并中重度三尖瓣关闭不全8例。手术采用双腔气管插管，单肺通气。股动、静脉插管，建立体外循环。右侧胸壁打孔，在胸腔镜辅助下进行二尖瓣手术。结果：40例患者住院期间无死亡，未发生术后低心排，术中转正中开胸等严重并发症，1例患者术后引流多，行二次胸腔镜下探查止血。全组患者二尖瓣成形26例，二尖瓣置换14例，其中8例同期行三尖瓣成形术。二尖瓣成形组行二尖瓣后叶部分切除并缝合15例、人工腱索18例、缘对缘技术2例、裂缺缝合1例、交界缝合3例，所有成形患者均使用二尖瓣成形环固定瓣环。结论：胸腔镜辅助二尖瓣手术治疗临床安全可行，对机体创伤小，美容效果好，具有良好应用前景。

【关键词】 胸腔镜手术； 二尖瓣手术； 价值

doi：10.14033/j.cnki.cfmr.2018.26.013 文献标识码 B 文章编号 1674-6805（2018）26-00-03

【Abstract】 Objective：To evaluate the safety and efficacy for patients undergoing mitral surgery with video-assisted thoracoscopic assistance（VATS）.Method：We retrospectively analyzed 40 patients who underwent VATS for mitral valve surgery in the department of cardiovascular surgery of Xiamen Cardiovascular Hospital from June 2015 to December 2017.There were 12 patients with rheumatic mitral valve disease，24 patients with degenerative mitral valve disease，4 patients with infective endocarditis and 8 patients associated with moderate to severe tricuspid regurgitation.All patients were ventilated with a double lumen endotracheal tube after general anesthesia.Superior vena cava，right femoral artery and vein cannulation were used to establish cardiopulmonary bypass（CPB）.Three holes were poked respectively in the intercostal space at right chest wall.Intracardial procedures were completed through video-assisted approach.Result：No patient was converted to median thoracotomy and no perioperative death was found，with 1 patient for re-exploration for bleeding.All procedures included，26 patients with mitral valve repair，12 patients with mitral valve replacement，concomitantly 8 patients with tricuspid valve repair.The mitral valve repair group included，15 patients with resection and suture of partial posterior mitral valve，18 patients with artificial chodae，2 patients with edge to edge technique，1 patient with fissure suture，3 patients with commissure suture，all mitral valve repair group patients treated with mitral prothetic ring.Conclusion：VATS for mitral valve surgery is a safe and feasible procedure with minimally invasive，low postoperative morbidity，good cosmetic results and wide application prospects.

【Key words】 Video-assisted thoracoscopic surgery； Mitral valve surgery； Value

First-authors address：Xiamen Cardiovascular Hospital Affiliated to Xiamen University，Xiamen 361004，China

隨着外科手术微创化，胸腔镜微创心脏手术在国内得到迅速发展。胸腔镜微创二尖瓣手术较传统正中开胸手术具有在不增加手术风险情况下创伤更小、失血少、术后恢复较快、远期生活质量较高的特点，在临床上已被医患双方所普遍接受，也逐渐得到越来越多临床应用[1-2]。厦门大学附属心血管病医院近3年应用胸腔镜下心脏微创手术为二尖瓣病变患者实施手术，总体手术效果满意，报道如下。……