Ebstein心脏畸形27例手术治疗体会  

Surgical Treatment for Ebstein's Anomaly in 27 Cases

作　　者：武刚[1] 张瑞成[2] 法宪恩[1] 赵根尚[1] 朱汝军[2] 

机构地区：[1]郑州大学第二附属医院心外科,郑州市450014 [2]河南省胸科医院心外科,郑州市450008

出　　处：《医药论坛杂志》2010年第22期91-93,共3页Journal of Medical Forum

摘　　要：目的总结Ebstein畸形外科治疗经验。方法 2005年5月—2010年2月间郑州大学第二附属医院与河南省胸科医院共行Ebstein畸形手术治疗27例,其中轻型4例,仅行DeVega三尖瓣成形术;中间型21例,16例折叠房化右心室并行三尖瓣成形,4例除行房化右心室折叠、三尖瓣成形术外,加做Gleen手术,1例行房化右心室折叠、三尖瓣成形及Fontan手术;重型2例行三尖瓣置换术。合并卵圆孔未闭或室间隔缺损均同期修补。结果手术死亡1例(3.7%)。术后超声心动图示,三尖瓣关闭良好17例,轻度关闭不全7例,中度关闭不全2例。术后24例随访5个月到8年,心功能(NYHA)恢复至正常9例,Ⅰ-Ⅱ级15例,均无远期死亡。结论 Eb-stein畸形应根据瓣叶发育情况和房化右心室大小选择手术术式,对于前瓣发育良好,房化右心室较小,应选房化右心室折叠术和三尖瓣成形术,对前瓣发育差,瓣下结构畸形严重,应行三尖瓣置换术。Objective To summarize the experience of surgical treatment for Ebstein＇s anomaly.Methods Totally 27 cases of Ebstein＇s anomaly underwent surgical treatment from May 2005 to February 2010.DeVege annuloplasty were performed in 4 cases of mild types.Atrialized ventricle plication and tricuspid valve plasty were performed in 16 cases of 21 moderate type.Except for atrialized ventricle plication and tricuspid valve plasty,Gleen procedure were added in 4 cases,Fontan procedure were added in 1 case.Tricuspid valve replacement were performed in 2 cases of severe types.Artial septal defect or ventricular septal defect were closed at the same time.Results There was one operative death（3.7%）.The postoperative echocardiography show that no regurgitation of tricuspid valve were in 17,mild regurgitation in 7,moderate regurgitation in 2 cases.24 cases were followed up,the follow-time ranged from 5 months to 8 years.The cardiac function（NYHA） of 9 cases recovered to normal,15 cases recovered to classⅠ~Ⅱ,there was no late death.Conclusion The surgical procedure of Ebstein＇s anomaly should be based on valve leaflet conditions and the size of atrialized ventricle.Patients with well developed anterior valve and small room of the atrialized ventricle,should receive atrialized ventricle plication and tricuspid valve plasty,Patients with poorly developed anterior valve and severe subvalvular abnormality should receive valve replacement.

关 键 词：EBSTEIN畸形 三尖瓣成形术 三尖瓣置换术 

分 类 号：R654.2[医药卫生—外科学]