腱索折叠与腱索转移矫治二尖瓣前瓣脱垂的比较分析  

Comparison Analysis Between Chordal Transposition and Chordal Shortening in Repairing Anterior Leaflet Prolapse

作　　者：陈伟[1,2] 张健群[1,2] 甘辉立[1,2] 周其文[1,2] 王胜洵[1,2] 李继勇[1,2] 郑斯宏[1,2] 孔晴宇[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京心肺血管疾病研究所心外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2010年第1期26-31,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较应用腱索折叠、腱索转移两种成形术式治疗二尖瓣前瓣脱垂(ALP)的效果,探讨两种术式的适应证、优缺点。方法回顾性分析1985年3月至2008年3月北京安贞医院应用腱索折叠、腱索转移两种成形术式治疗的90例ALP患者的临床资料,按采用的手术方法不同分为腱索折叠组(n=23例)和腱索转移组(n=67例)。建立两组患者的Kaplan-Meier生存曲线及免除再次手术曲线,并进行对比分析;对影响早期死亡及晚期心脏事件的危险因素进行单因素和多因素logistic回归分析。结果围术期死亡6例(6.59%),其中腱索折叠组死亡3例(13.0%),腱索转移组3例(4.4%),两组比较差异无统计学意义(χ2=2.019,P=0.155)。随访时间为1个月～18年(7.70±5.41年),晚期死亡5例,其中腱索折叠组3例,腱索转移组2例。Kaplan-Meier生存曲线结果:5年生存率腱索折叠组低于腱索转移组,差异有统计学意义(70.00%±18.24%vs.98.00%±1.98%,χ2=12.50,P=0.000);5年免除再次手术率腱索折叠组低于腱索转移组,差异有统计学意义(83.30%±15.20%vs.96.10%±2.71%,χ2=10.27,P≤0.001)。单因素分析结果:年龄>55岁、同期施行冠状动脉旁路移植术(CABG)、术前心功能Ⅲ级或Ⅳ级、术前有心力衰竭史、主动脉阻断时间>90min、术前左心室射血分数(LVEF)<45%是影响早期死亡的危险因子;术后中度以上二尖瓣反流、腱索折叠、术前有心力衰竭史、主动脉阻断时间>90min为影响晚期心脏事件的危险因子。经多因素logistic回归分析结果:主动脉阻断时间>90min、同期CABG、术前LVEF<45%是影响早期死亡的危险因子;术后心功能Ⅲ级或Ⅳ级、腱索折叠残存二尖瓣2+以上反流为影响晚期心脏事件的独立危险因子。结论腱索转移、腱索折叠两种成形技术治疗ALP的围术期生存率差异无统计学意义;腱索转移术的5年生存率优于腱索折叠术,腱索转移术的中长期免除再手术率优于腱索折叠术;但�Objective To compare chordal transposition and chordal shortening in repairing anterior leaflet prolapse （ALP）, and explore the surgical indications as well as merits and demerits of these two techniques. Methods We retrospectively reviewed the data of 90 ALP patients recruited into Anzhen Hospital between March 1986 and March 2008, and classified them into chordal shortening group （n=23） and chordal transposition group （n=67）. Kaplan-Meier survival curve and freedom from reoperation curve were established to compare the two groups. Univariate analysis and multivariate logistic analysis regression were used to identify independent risk factors for early death and late cardiac events. Results There were three perioperative deaths in chordal shortening group（13.0%）, and three deaths in chordal transposition group （4.4%）, and the difference was not significant （χ2=2.019,P=0.155）. The follow-up time ranged from 1 month to 18 yrs（7.70±5.41 yrs）. There were 5 late deaths, of which 3 were in chordal shortening group and 2 in chordal transposition group. The Kaplan-Meier survival curve showed that 5-year survival rate of chordal shortening group was significantly lower than chordal transposition group （70.00%±18.24% vs.98.00%±1.98%,χ2=12.50, P=0.000）; And the Kaplan-Meier freedom from reoperation curve showed that 5-year reoperation rate of chordal shortening group was also significantly lower than chordal transposition group （83.30%±15.20% vs.96.10%±2.71%,χ2=10.27,P≤0.001）. By the univariate analysis, we found that age〉55 yrs old, concomitant CABG procedure, New York Heart Association （NYHA） function class Ⅲ-Ⅳ, preoperative heart failure history, aortic clamping time〉90 min, and preoperative lefe ventricular ejection fraction （LVEF）〈45% were the risk factors for perioperative death and risk factors for late cardiac events included postoperative mitral regurgitation〉2＋, chordal shortening technique, preoperative heart failure history, and aortic clamping

关 键 词：二尖瓣 前瓣脱垂 二尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]