本文選題：微創(chuàng)手術(shù) + 正中切口手術(shù)�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:對(duì)比右胸微創(chuàng)小切口與傳統(tǒng)胸部正中切口行左心房粘液瘤摘除術(shù)的安全性及臨床療效。材料及方法:選擇2011年07月至2017年02月吉林大學(xué)第二醫(yī)院心血管外科施行右胸微創(chuàng)小切口左心房粘液瘤摘除術(shù)39例患者作為小切口組,同期收治的30例行傳統(tǒng)胸部正中切口的左心房粘液瘤患者作為對(duì)照組。小切口組共有39例左心房粘液瘤患者,均根據(jù)病史、�？撇轶w、心臟超聲心動(dòng)圖等檢查確診為左心房粘液瘤疾病,其中單純左心房粘液瘤17例,合并二尖瓣返流6例,合并三尖瓣返流6例,合并二尖瓣及三尖瓣返流10例。對(duì)照組中單純左心房粘液瘤14例,合并二尖瓣返流5例,合并三尖瓣返流4例,合并二尖瓣及三尖瓣返流7例。收集并比較兩組患者的院內(nèi)死亡率,主動(dòng)脈阻斷時(shí)間、轉(zhuǎn)機(jī)時(shí)間、手術(shù)時(shí)間、術(shù)后機(jī)械通氣時(shí)間、ICU停留時(shí)間、術(shù)后24h引流量、二次開胸止血率、術(shù)后輸血量、下地活動(dòng)時(shí)間、住院時(shí)間以及術(shù)后并發(fā)癥發(fā)生率,以及術(shù)后6個(gè)月、1年、3年行門診和/或電話隨訪結(jié)果。運(yùn)用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,計(jì)量資料以(?)表示,兩組之間采用獨(dú)立樣本t檢驗(yàn)比較;計(jì)數(shù)資料以例數(shù)(%)表示,兩組之間采用X~2檢驗(yàn)比較。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:所有患者均順利完成手術(shù),術(shù)中摘除物病理檢查結(jié)果均證實(shí)為粘液瘤,兩組圍術(shù)期均無(wú)死亡病例。小切口組患者,切口長(zhǎng)度(4-6)cm,平均(5.2±1.2)cm。小切口組主動(dòng)脈阻斷時(shí)間、轉(zhuǎn)機(jī)時(shí)間以及手術(shù)時(shí)間長(zhǎng)于對(duì)照組(P0.05),而術(shù)后機(jī)械通氣時(shí)間、ICU停留時(shí)間、術(shù)后24h引流量、二次開胸止血率、術(shù)后輸血量、下地活動(dòng)時(shí)間、住院時(shí)間較對(duì)照組均有統(tǒng)計(jì)學(xué)意義的縮短或減少(P0.05)。小切口組以及對(duì)照組術(shù)后均無(wú)腎功能衰竭、其他重要臟器衰竭、神經(jīng)系統(tǒng)等并發(fā)癥。小切口組有1例發(fā)生切口脂肪液化,經(jīng)換藥后愈合,而對(duì)照組有1例發(fā)生縱隔感染,經(jīng)清創(chuàng)縫合后愈合。兩組患者術(shù)后6個(gè)月、1年、3年行隨訪,隨訪期間,兩組均無(wú)死亡、無(wú)復(fù)發(fā),心功能均明顯好轉(zhuǎn)。結(jié)論:采用右胸微創(chuàng)小切口行左心房粘液瘤摘除術(shù)安全可行,療效確切,且具有明顯的優(yōu)越性,值得推廣。
[Abstract]:Objective: to compare the safety and clinical effect of left atrial myxoma resection with right thoracic minimally invasive incision and traditional median thoracotomy. Materials and methods: from July 2011 to February 2017, 39 patients with left atrial myxoma underwent minimally invasive left atrial myxoma resection in the second Hospital of Jilin University were selected as the small incision group. Thirty patients with left atrial myxoma treated with traditional median thoracotomy were treated as control group. In the small incision group, 39 patients with left atrial myxoma were diagnosed as left atrial myxoma according to their history, physical examination and echocardiography, including 17 cases of left atrial myxoma and 6 cases of mitral regurgitation. There were 6 cases with tricuspid regurgitation and 10 cases with mitral and tricuspid regurgitation. In the control group, 14 cases of left atrial myxoma, 5 cases of mitral regurgitation, 4 cases of tricuspid regurgitation, 7 cases of mitral and tricuspid regurgitation were found. The hospital mortality, aortic clamping time, transit time, operation time, postoperative mechanical ventilation time and ICU stay time, postoperative 24 h drainage flow, rethoracotomy hemostasis rate, postoperative blood transfusion volume, subsurface activity time were collected and compared between the two groups. The duration of hospitalization, the incidence of postoperative complications, and the results of outpatient and / or telephone follow-up at 6 months, 1 year and 3 years after operation. Use SPSS 19.0 software to carry on the statistics processing, the metrological data is used to be accurate) The results showed that the two groups were compared by independent sample t-test, and the counting data were expressed by examples. The difference between the two groups was statistically significant by using Xan2 test. P05 was the difference between the two groups. Results: all the patients completed the operation successfully, and the pathological examination of extirpation proved myxoma, and there were no death cases in both groups during perioperative period. In the small incision group, the incision length was 4-6 cm (mean 5.2 鹵1.2 cm). The aortic clamping time, transit time and operation time in the small incision group were longer than those in the control group (P 0.05), but the mechanical ventilation time after operation was longer than that in the control group, and the duration of mechanical ventilation was the time of staying in ICU, the drainage flow at 24 hours after operation, the hemostasis rate of second thoracotomy, the amount of blood transfusion after operation, and the time of ground movement. Compared with the control group, the hospitalization time was significantly shortened or decreased (P 0.05). There were no renal failure, other important organ failure and nervous system complications in small incision group and control group. In the small incision group, 1 case had incision fat liquefaction and healed after dressing change, while in the control group, 1 case had mediastinal infection and healed after debridement and suture. The patients in both groups were followed up for 6 months, 1 year and 3 years after operation. During the follow-up period, there was no death, no recurrence and significant improvement of cardiac function in both groups. Conclusion: the right thoracic minimally invasive small incision for left atrial myxoma excision is safe and effective, and has obvious advantages, which is worth popularizing.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R732.1

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