8例心内膜心肌纤维化的诊疗经验  

The experience of diagnosis and treatment of 8 cases endomyocardial fibrosis

作　　者：梁葳[1] 王茂生[1] 秦太昌[1] 李韬[1] 

机构地区：[1]广东省茂名市人民医院心胸外科,广东茂名525000

出　　处：《河北医学》2004年第8期742-745,共4页Hebei Medicine

摘　　要：目的 :总结 8例心内膜心肌纤维化 (EMF)的诊断和治疗经验。方法 :对有不明原因的心力衰竭并考虑为EMF的 8例患者施行超声心动图 (UCG)、核磁共振成象 (MRI)、心内膜心肌活检(EMB)等检查 ,4例予内科治疗 ,4例行外科手术。结果 :UCG、MRI、EMB获得EMF诊断的例数分别为3/ 8、4 / 4、3/ 4,同时行以上三种检查诊断的例数为 3/ 3。 4例患者经内科治疗 ,2周至半年内全部死亡。2例患者施行右室心内膜切除加三尖瓣成形术 ,术后恢复良好 ,随访 6～ 9年 ,心功能 2级 ,能从事轻度工作。 2例行右室心内膜切除加三尖瓣置换术 ,手术死亡 1例 ,1例存活 6年 ,死于心力衰竭。结论 :综合应用UCG、MRI、EMB可提高EMF的诊断率 ,对病变较轻的EMF患者行心内膜切除加瓣膜成形或置换术可获得良好的效果 。Objective: To report the experience of diagnosisand treatment of 8 cases of endomyocardial fibrosis.Method: Echocardiography(UCG),magnetic resonance imaging(MRI) and endomyocardial biopsy(EMB) were performed in 8 patients who presented heart failure of unknow etiology and had been considered as EMF.4 patients received physician therapy,4 patients received surgical operation. Result: The results showed that the diagnosis cases'number of UCG,MRI,EMB for EMF are 3/8,4/4,3/4,respectively. The diagnosis cases' number of comprehensive utilizing UCG , MRI and EMB are 3/3.4 patients who received physician therapy died of heart failure within two weeks to half year.Right ventricular endocardiectomy and tricuspid valve repair have been performed in 2 patients with mild EMF.They had a satisfactory recovery postoperatively.Six to nine years follow up revealed that cardiac function improved to 2 class ,and patients was able to return to light work.Right ventricular endocardiectomy and tricuspid valve replacement have been performed in 2 patients with severe EMF.There was one operative death.Other patient have survived for six years and died of heart failure at last.Conclusion: Comprehensive utilizing UCG,MRI and EMB to examination can increase the diagnostic rate of EMF.Ventricular endocardiectomy and valve repair or replacement performed in patient with mild EMF should get good result,the patient with severe EMF should receive heart transplant.

关 键 词：心内膜心肌纤维化 超声心动图 核磁共振成象 心内膜心肌活检 心内膜 切除术 瓣膜成形或置换术 

分 类 号：R654.2[医药卫生—外科学]