慢性缺血性二尖瓣关闭不全的外科治疗  

Surgical treatment of chronic ischemic mitral regurgitation

作　　者：周仲毅[1] 王忠华[1] 李悟[1] 周平[1] 王卫东[1] 

机构地区：[1]兰州军区乌鲁木齐总医院心胸外科,新疆乌鲁木齐830000

出　　处：《西北国防医学杂志》2010年第3期184-186,共3页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的：探讨慢性缺血性二尖瓣关闭不全（IMR）的手术治疗方法和效果。方法：2004-04~2008-09,冠脉搭桥同期外科治疗IMR 21例,其中中度反流17例,重度反流4例。二尖瓣成形术6例,其中使用人工瓣环4例。瓣膜置换术15例,其中双叶机械瓣8例、生物瓣7例。结果：全组手术死亡1例。17例术后平均随访24个月,远期死亡1例,生存者远期心功能l~Ⅱ级者16例,Ⅲ级者1例。术后超声复查左心室内径较术前明显缩小,瓣膜功能良好。结论：中度和中度以上缺血性二尖瓣关闭不全在作冠脉搭桥术时应同时手术处理病变的瓣膜,术后效果满意。而手术矫治的方法应根据瓣膜的病理改变和手术者的经验决定。Objective：To discuss the surgical technique and therapeutic results of ischemic mitral regurgitation（IMR）.Methods：From April 2000 to September 2004,21 patients with moderate（n=17） or severe（n=4） IMR underwent coronary artery bypass grafting（CABG） combined with mitral valvuloplasty（MVP,n=6） or mitral valve replacement（MVR,n=15）.The annuloplasty ring was used in 6 patients underwent MVP.In MVR group,the mechanical valves were implanted in 8 patients and biological prostheses were used in 7.Results：The operative mortality was 4.8%（1/21）.Eighteen patients were followed up for 10 to 36 months（mean=24 months）.One case of late death was recorded.Sixteen survivors showed the NYHA functional class Ⅰ-Ⅱ,and 1 survivor showed the class Ⅲ.Ultrasonic cardiograph showed obvious decrease of left ventricular internal diameter and good valve function.Conclusion：The moderate to severe IMR treated with CABG should be combined with MVP or MVR.The choice of protocol depends on the mitral pathology and experience of surgeon.

关 键 词：二尖瓣关闭不全 缺血 外科手术 

分 类 号：R654.2[医药卫生—外科学]