| Objectives:Through the study of the experiment for20dogs with totally thoracoscopic mitral valve replacement, for30cases of mitral valve with totally thoracoscopic mitral valve replacement, and for30cases clinical similar patients with open-chest surgery,this subject aims to explore:(1) Through animal experiments, Establish the standard methods of totally thoracoscopic mitral valve replacement surgery, analysis of the risk factors in operating process, seek the solution, and avoid these risk factors.(2) Through the clinical study, with the better method from animal experiments, then have the surgery for30cases with this method, it is the experimental group,the other is control group,and we have the surgery with open-chest method in this group. At last, we recorded the cardiopulmonary bypass time, aortic cross clamping time, operating time,assisted respiration time,in hospital time, amount of thoracic drainage, and result of treatment.comparison of the method is equal or better than traditional open-chest surgery, seek the minimal invasive data, and provide the theoretical basis for totally thoracoscopic mitral valve replacement.Methods:(1) Animal experiments:20adult mongrel dogs, male or female, weight20-5kg or so, Dogs were fasted12hours before operation, tracheal intubation, Ventilator small tide volume high frequency ventilation method, stripping right femoral artery and femoral vein, establish extracorporeal circulation, on the third and seventh rib clearance of right axillary midline, and the fifth rib clearance beside of the sternum, cut a1.5cm small incision respectively respectively for surgical instruments holes and thoracoscope placed holes. Then cut the left atrium, Explore the mitral valve, grouping experiment, Application of single needle double needle continuous suture and interrupted mattress suture were performed in10cases of animal experiment. Then record the mitral valve replacement time and the numbers of setting lines of each method, summarize their advantages and disadvantages, find the most suitable operation method, and provide the theoretical basis for totally thoracoscopic mitral valve replacement.(2) Clinical application:Diagnose the mitral valve disease through patients symptoms, ECG,USG and X-ray, all the cases are adult, no others symptoms, all the cases have the mitral valve replacements, select60these cases, It will be randomly divided into totally thoracoscopic group and median thoracotomy group, there were no significant difference in age, NYHA, sex and weight, Then have the operation treatment for the two groups patients, Record the extracorporeal circulation time, Aortic cross clamping time, operating time, Mechanical ventilation time, The amount of thoracic drainage, in hospital time and treatment effect. Analysis of this method is equal to or better than traditional open chest operation, seek the minimal invasive data, and provide the theoretical basis for totally thoracoscopic mitral valve replacement,Results:(1) Animal experiments:Through the experimental analysis, Double needle interrupted mattress suture is superior than single needle continuous suture in operating time and numbers of setting lines, analysis these results, Single continuous needle stitching seem simple, But it is very difficult in the process of operation, Mainly because microscopic vision is limited clinical research:The clinical analysis of two groups of patients were compared, Complete mitral valve replacement operation and traditional thoracoscopic thoracic operation has the remarkable difference in the hospitalization time、Chest tube drainage,(P<0.05), hasno significant differences in aortic cross clamping time、 cardiopulmonary bypass time、ICU stay time、mechanical ventilation time etc。(P>0.05)。Conclusion:(1) animal experiment:Through the comparative analysis of animal experiment, In completely thoracoscopic mitral valve replacement, application of double needle interrupted mattress suture is more feasible, It can save operation time, to ensure the operation safety。(2) clinical research:Complete mitral valve replacements and traditional median thoracoscopic thoracic operation compared, It is also safe and effective, Patients with less drainage, less blood transfusion, short the hospitalization time, little operation wound, Without the transected sternal,Incision is beautiful and hidden, Psychological trauma, Social activity recovery, In line with the modern health concept, worthy of promotion。... |
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