简化体外循环在全胸腔镜再次三尖瓣手术中的应用

任培军; 王圣; 李建朝; 钱晓亮; 王保才; 程兆云

doi:10.13201/j.issn.1001-1439.2025.03.011

简化体外循环在全胸腔镜再次三尖瓣手术中的应用

- 1.
  阜外华中心血管病医院河南省人民医院心脏中心郑州大学华中阜外医院体外循环科(郑州，450046)
- 2.
  阜外华中心血管病医院河南省人民医院心脏中心郑州大学华中阜外医院心血管外科
基金项目:
郑州市科技惠民计划项目(No：2022KJHM0036)

详细信息

通讯作者: 程兆云，E-mail：Chengzhy@zzu.edu.cn

中图分类号: R654.2

收稿日期: 2024-05-21

刊出日期: 2025-03-13

Application of simplified cardiopulmonary bypass in total thoracoscopic reoperation tricuspid valve surgery

- 1.
  Department of Extracorporeal Circulation
- 2.
  Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Henan Provincial People's Hospital Heart Center, Zhengzhou University Fuwai Hospital Central China, Zhengzhou, 450046, China

More Information

Corresponding author: CHENG Zhaoyun, E-mail: Chengzhy@zzu.edu.cn

Received Date: 21 May 2024

Publish Date: 13 March 2025

摘要

摘要: 目的探讨简化体外循环在全胸腔镜再次三尖瓣手术中应用的安全性。方法回顾性收集2020年6月—2023年12月在我院行简化体外循环下全胸腔镜再次三尖瓣手术的16例患者的临床资料。所有患者均采用单根多侧孔股静脉引流加股动脉灌注的插管方式行简化体外循环下全胸腔镜手术。统计手术时间、体外循环时间和术后带呼吸机时间。结果 16例患者中，14例行三尖瓣置换术，2例行三尖瓣修复。手术时间(144.8±20.6) min，体外循环时间(76.4±11.7) min。无体外循环相关神经系统并发症。术后带呼吸机时间(17.3±3.8) h，ICU停留时间(24.4±5.4) h，术后平均住院时间(5.8±2.0) d。结论简化体外循环应用于全胸腔镜再次三尖瓣手术，简化了手术操作，围术期结果满意，值得临床推广应用。
- 简化体外循环 /
- 再次手术 /
- 全胸腔镜 /
- 三尖瓣
Abstract: Objective To explore the safety of simplified cardiopulmonary bypass in total thoracoscopic reoperation tricuspid valve surgery.Methods The clinical data of 16 patients who underwent total thoracoscopic reoperation valve surgery under simplified cardiopulmonary bypass in our hospital from June 2020 to December 2023 were retrospectively collected. All patients underwent total thoracoscopic surgery under simplified cardiopulmonary bypass using a single multi-side hole femoral venous drainage cannula and femoral artery perfusion. The operation time, extracorporeal circulation time, and postoperative ventilator time were counted.Results Among the 16 patients, 14 underwent tricuspid valve replacement, and 2 underwent tricuspid valve repair. The operation time was(144.8±20.6) min, and the extracorporeal circulation time was(76.4±11.7) min. There were no neurological complications related to cardiopulmonary bypass. The postoperative ventilator time was(17.3±3.8) h, the ICU stay time was(24.4±5.4) h, and the average postoperative hospital stay was(5.8±2.0) d.Conclusion Simplified cardiopulmonary bypass is used in total thoracoscopic reoperation tricuspid valve surgery, which simplifies the surgical operation and has satisfactory perioperative results, and is worthy of clinical promotion and application.
- simplified cardiopulmonary bypass /
- reoperation /
- total thoracoscopy /
- tricuspid valve

HTML全文

图 1 全胸腔镜手术切口位置

Figure 1. The incision location for total thoracoscopic surgery

下载: 全尺寸图片幻灯片

图 2 三尖瓣术野暴露

Figure 2. Exposure of the tricuspid valve surgical field

下载: 全尺寸图片幻灯片

表 1 患者临床资料

Table 1. Clinical data 例(%), X±S

项目	数据
既往外科手术
二尖瓣置换术	10(62.5)
二尖瓣置换术+三尖瓣成形术	3(18.7)
二尖瓣置换术+主动脉瓣置换术	2(12.5)
冠状动脉旁路移植术	1(6.3)
NYHA分级
Ⅲ	9(56.2)
Ⅳ	7(43.8)
EuroSCORE评分	9.4±2.3
左室射血分数/%	46.4±8.5
肺动脉压/mmHg	38.3±7.3
肌酐/(μmol/L)	85.6±40.0
胆红素/(μmol/L)	19.9±12.3
高血压	7(43.8)
糖尿病	5(31.3)
慢性阻塞性肺疾病	3(18.8)
心房颤动	2(12.5)
EuroSCORE：欧洲心血管手术风险评估系统。

下载: 导出CSV

表 2 患者术中及术后观察指标

Table 2. Observation indicators during and after surgery X±S

项目	数据
体外循环建立时间/min	19.8±4.4
体外循环时间/min	76.4±11.7
手术时间/min	144.8±20.6
输注红细胞量/U	0.5±1.2
术后24 h引流量/mL	182.8±71.7
带呼吸机时间/h	17.3±3.8
ICU停留时间/h	24.4±5.4
术后平均住院时间/d	5.8±2.0

下载: 导出CSV

参考文献(14)

[1]	Yang L, Chen H, Pan W, et al. Analyses for Prevalence and Outcome of Tricuspid Regurgitation in China: An Echocardiography Study of 134, 874 Patients[J]. Cardiology, 2019, 142(1): 40-46. doi: 10.1159/000496601
[2]	Lu S, Song K, Yao W, et al. Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery[J]. J Cardiothorac Surg, 2020, 15(1): 146. doi: 10.1186/s13019-020-01192-1
[3]	Lee TC, Desai B, Glower DD. Results of 141 consecutive minimally invasive tricuspid valve operations: an 11-year experience[J]. Ann Thorac Surg, 2009, 88(6): 1845-1850. doi: 10.1016/j.athoracsur.2009.08.052
[4]	Abdelbar A, Niranjan G, Tynnson C, et al. Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option[J]. Innovations, 2020, 15(1): 66-73.
[5]	Minol JP, Boeke U, Weinreich T, et al. Isolated Tricuspid Valve Surgery: A Single Institutional Experience with the Technique of Minimally Invasive Surgery via Right Minithoracotomy[J]. Thorac Cardiov Surg, 2015, 65(8): 606-611.
[6]	刘爽爽, 宋亚男, 李民. 经食道超声心动图在微创心脏手术中的应用进展[J]. 中国微创外科杂志, 2023, 23(10): 759-763. doi: 10.3969/j.issn.1009-6604.2023.10.008
[7]	Al-Hijji M, Fender EA, El Sabbagh A, et al. Current Treatment Strategies for Tricuspid Regurgitation[J]. Curr Cardiol Rep, 2017, 19(11): 106. doi: 10.1007/s11886-017-0920-4
[8]	刘冰, 姜胜利. 左心瓣膜术后重度三尖瓣关闭不全微创手术的疗效及安全性分析[J]. 解放军医学杂志, 2020, 45(2): 206-211.
[9]	陈凌, 孙杰, 陈昊, 等. 心脏瓣膜置换术后病人接受普通外科手术安全性评价[J]. 中国实用外科杂志, 2019, 39(11): 1203-1210.
[10]	申宏, 何潇一, 姜胜利. 左心瓣膜术后单纯性三尖瓣关闭不全的微创治疗方案及围术期结果[J]. 中国临床新医学, 2024, 17(3): 252-257. doi: 10.3969/j.issn.1674-3806.2024.03.03
[11]	邓勇志, 李楠. 从"巨创"到"微创"——微创瓣膜疾病治疗进展[J]. 临床心血管病杂志, 2024, 40(6): 433-436. doi: 10.13201/j.issn.1001-1439.2024.06.001
[12]	Margari V, Malvindi PG, De Santis A, et al. Minimally invasive tricuspid valve surgery without caval occlusion: Short and midterm results[J]. J Cardiac Surg, 2021, 36(2): 618-623. doi: 10.1111/jocs.15278
[13]	Asta L, Benedetto U, Tancredi FC, et al. Minimally Invasive Strategy to Repair Mitral Valve after Repeated Coronary Revascularization: A Case Report and Literature Review[J]. J Clin Med, 2023, 12(22): 7096. doi: 10.3390/jcm12227096
[14]	Liu H, Liao S, Lin Z, et al. Total Thoracoscopic Surgery for Late Mitral Paravalvular Leakage Repair in A Beating Heart[J]. Braz J Cardiov Surg, 2023, 38(1): 175-178.