小胸切除术与常规胸切除术用于关膜修复:随机临床试验
Enoch F Akowuah1, Rebecca H Maier2, Helen C Hancock3
1Department of Cardiac Surgery, the James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom.
JAMA
|June 14, 2023
概括
至少侵入性膜修复 (小胸切除术) 在身体功能恢复方面没有优于传统的中间胸切除术. 这两种方法都提供了可比的高质量修复和对退行性心肌吐的安全结果.
科学领域:
- 心血管外科
- 最少侵入性手术
- 心脏门的修复
背景情况:
- 胸腔导向小胸口切除术与中枢胸口切除术在退行性胸腔吐时的相对安全性和有效性仍然不确定.
- 退行性膜反会影响大量需要手术的患者群体.
研究的目的:
- 在一项随机试验中,比较小胸口切除术与胸口切除术的安全性和有效性.
- 评估手术后的身体功能恢复和恢复正常活动.
主要方法:
- 这是一项实用,多中心,优越,随机的临床试验,涉及330名在英国10个三级医疗机构的成年患者.
- 参与者被随机分为1:1接受由专家外科医生进行的迷你胸口切除术或胸口切除术.
- 通过12周的SF-36身体功能量表来评估主要结果,其次要结果包括1年内的额头吐度,身体活动,生活质量和安全事件.
主要成果:
- 在12周内,微胸切除术和胸膜切除术之间的SF-36身体功能T评分的平均变化没有显著差异 (差异为0. 68;95% CI,-1. 89至3. 26).
- 两组都显示出高和相似的 mitra 修复率 (约96%) 和优秀的长期结果,其中92%的参与者在1年内没有或有轻微的 mitra 吐.
- 综合安全结果 (死亡,重复手术或心力衰竭住院) 在1年后发生在5. 4%的小胸切除组和6. 1%的胸切除组中,两种方法之间没有显著差异.
结论:
- 胸腔镜引导的微型胸腔切除术在12周后改善膜退化后的身体功能恢复方面并不优于中部胸腔切除术.
- 微型胸腔切除术提供高速率和高质量的门修复,其安全结果与1年后的胸腔切除术相美.
- 这些发现支持共享决策,并可为手术治疗中门修复提供指导.
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