目的总结右胸前第3肋间小切口瓣膜置换/成形术的技术要点。 方法回顾性分析2011年1月至2014年6月我院行右胸前第3肋间小切口心脏瓣膜手术129例的临床资料，其中男57例、女72例，年龄23～65（42±17）岁。瓣膜病变患者股动静脉插管建立体外循环、经右胸前第3肋间小切口行瓣置换/成形术，其中行二尖瓣置换术49例，二尖瓣成形术21例，主动脉瓣置换术33例，二尖瓣+主动脉瓣双瓣膜置换术26例。 结果129例手术均顺利完成，切口长度5～7 cm，无感染及神经系统并发症发生，住院时间10～14 d，均痊愈出院。随访1～30个月，患者心功能改善，无死亡病例。 结论右胸前第3肋间小切口行瓣膜手术安全可靠，创伤小并具有美容效果。
ObjectiveTo analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.MethodsThe clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared.ResultsThere were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05).ConclusionThe aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.