[1]郑富臻 翁国星** 赖宝春 鲍家银 王欢 陈智群 谢琦 严李程.二尖瓣机械瓣膜置换术后三尖瓣重度关闭不全行全胸腔镜下三尖瓣生物瓣置换[J].中国微创外科杂志,2019,01(3):236-238.
　Zheng Fuzhen,Weng Guoxing,Lai Baochun,et al.Videoassisted Thoracoscopic Tricuspid Biological Valve Replacement Surgery for Severe Tricuspid Incompetence After Mitral Valve Replacement[J].Chinese Journal of Minimally Invasive Surgery,2019,01(3):236-238.
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二尖瓣机械瓣膜置换术后三尖瓣重度关闭不全行全胸腔镜下三尖瓣生物瓣置换()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2019年3期
页码:
236-238
栏目:
临床研究
出版日期:
2019-03-25

文章信息/Info

Title:
Videoassisted Thoracoscopic Tricuspid Biological Valve Replacement Surgery for Severe Tricuspid Incompetence After Mitral Valve Replacement
作者:
郑富臻 翁国星** 赖宝春 鲍家银 王欢 陈智群 谢琦 严李程
（福建省立医院心血管外科福建省立金山医院，福州350001）
Author(s):
Zheng Fuzhen;  Weng Guoxing;  Lai Baochun;  et al.
Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou 350001, China
关键词:
胸腔镜; 二尖瓣置换术; 三尖瓣关闭不全; 三尖瓣生物瓣置换
Keywords:
Thoracoscope; Mitral valve replacement; Tricuspid incompetence; Tricuspid biological valve replacement
文献标志码:
A
摘要:
目的探讨二尖瓣机械瓣膜置换术后远期出现三尖瓣重度关闭不全，再次手术行胸腔镜下三尖瓣生物瓣置换的近期疗效。 方法2016年4月～2017年12月对15例二尖瓣机械瓣膜置换术后三尖瓣重度关闭不全行胸腔镜下三尖瓣生物瓣置换。全麻取右侧锁骨中线至右侧腋前线第4肋间切口，长约3.5 cm，为主操作孔，腋中线第3肋间切口为副操作口，右侧腋中线第5肋间为观察口，切开心包及右房壁，心脏不停跳行三尖瓣生物瓣置换术。 结果无死亡，手术时间（4.3±14）h，体外循环时间（1.5±0.4）h，ICU 滞留时间（3.6±2.9）d，呼吸机使用时间（65±7）h，术后 24 h 引流量（448±127） ml，住院时间（9.2±7.6）d。15例随访6～30个月，（8.3±6.7）月，三尖瓣均未见明显返流，术后心功能恢复至Ⅰ级 3例，Ⅱ级8例，Ⅲ级4例。结论胸腔镜三尖瓣生物瓣置换术近期疗效满意，可作为二尖瓣机械瓣膜置换术后远期出现三尖瓣重度关闭不全的优选治疗方式。
Abstract:
ObjectiveTo summarize the shortterm outcomes of videoassisted thoracoscopic tricuspid biological valve replacement surgery in the treatment of severe tricuspid incompetence after leftsided valve surgery.MethodsFifteen patients with severe tricuspid incompetence underwent leftsided tricuspid valve replacements in our hospital from April 2016 to June 2017. Under general anesthesia, an incision along the fourth intercostal space from the middle line of the right clavicle to the front line of the right axilla, about 3.5 cm in length, was performed as the main operating hole. Another incision at the third intercostal space on the middle line of the axilla was used as secondary operating port. A fifth intercostal incision in the middle line of the right axilla was used as the observation port. The pericardium and the right atrial wall were incised. The tricuspid valve was replaced with biological valve in the beating heart. ResultsNo deaths occurred in the intraoperative period. The operation time was (4.3±1.4) h, the extracorporeal circulation time was (1.5±0.4) h, the ICU retention time was (3.6±2.9) d, The ventilation time was (65±7) h, the postoperative drainage volume was (448±127) ml, and the hospitalization time was (9.2±7.6) d. All the 15 patients were followed up for 6-30 months (mean, 8.3±6.7 months) without significant tricuspid regurgitation. Cardiac function recovered to grade Ⅰ in 3 cases, grade Ⅱ in 8 cases and grade Ⅲ in 4 cases.ConclusionsVideoassisted thoracoscopic tricuspid biological valve replacement surgery is reliable and obtains fast recovery. The shortterm curative effect is satisfactory. It can be a better method for treating severe tricuspid incompetence after mitral valve replacement.

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备注/Memo

备注/Memo:
基金项目：2018年福建省卫生计生青年科研课题（2018-2-1）**通讯作者，Email：gxw001@sina.com
更新日期/Last Update: 2019-06-04