保留二尖瓣后瓣叶及瓣下结构的二尖瓣置换术的临床经验  

Replacements with mitral valve preserving mitrai posterior leaflet and subvaive structures:a clinical experience with 1 050 cases

作　　者：焦国庆[1] 肖明第[1] 林雷[1] 叶一舟[1] 袁忠祥[1] 卢成宝[1] 吕志前[1] 

机构地区：[1]上海交通大学附属第一人民医院心血管外科,200080

出　　处：《上海医学》2008年第6期391-393,共3页Shanghai Medical Journal

摘　　要：目的总结保留二尖瓣后瓣叶及瓣下结构的二尖瓣置换术的临床经验和治疗效果。方法自1997年10月—2006年3月完成保留二尖瓣后瓣叶及瓣下结构的二尖瓣置换术1050例,男487例,女563例,其中合并风湿性心脏瓣膜病753例,严重冠状动脉性心脏病52例。结果术后早期病死率为3.43%,并发症发生率为5.05%。术后3个月心脏超声检查显示左心室舒张末期直径(LVDD)、左心室收缩末期直径(LVSD)改善最为明显,LVDD、LVSD分别减小(3.57±1.32)%和(2.82±0.82)%;术后6个月分别减小(2.77±0.84)%和(2.35±0.74)%;术后12个月分别减小(1.51±0.64)%和(0.93±0.61)%。结论保留二尖瓣后瓣叶及瓣下结构二尖瓣置换术适用于大部分二尖瓣病变,可减少左心室破裂的危险,改善术后心功能。Objective To summarize our experience and the clinical outcomes of valve replacements with mitral valves preserving the posterior leaflet and subvalve structures. Methods From October 1997 to March 2006, 1050 patients, including 487 males and 563 female, underwent mitral valve replacements with preserva tion of mitral posterior leaflet and subvalve structures; among them 753 cases also suffered from rheumatic heart diseases and 52 patients had servere coronary artery disease. Results The incidences of mortality and complication were 3.43% and 5.05%, respectively early after operation. Left ventricular end diastolic diameter （LVDD） and left ventricular end-systolic diameter （LVSD） reduced by （3.57±1.32）% and （2.82±0.82）%, respective ly 3 months after treatment; reduced by （2. 77±0.84）% and （2. 35±0. 74）%, respectively 6 months after treatment; reduced by （1. 51±0.64）% and （0.93±0.61）%, respectively 12 months after treatment. Conclusion Mitral valve replacements with preservation of mitral posterior leaflet and subvalve structures is a safe and effective surgical technique; it can reduce the risk of postoperative left ventricle rupture and improve the left vent ricular ejection fraction.

关 键 词：二尖瓣置换术 心脏外科 二尖瓣狭窄 

分 类 号：R654.2[医药卫生—外科学] R318.11[医药卫生—临床医学]