重度三尖瓣病变行三尖瓣置换术27例临床应用  

Tricuspid valve replacement in the treatment of severe tricuspid valve disease： a report of 27 cases

作　　者：宣海洋[1] 石开虎[1] 张飞[1] 徐盛松[1] 龚文辉[1] 

机构地区：[1]安徽医科大学第二附属医院胸心外科,合肥230601

出　　处：《中国医师进修杂志》2011年第32期20-22,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨三尖瓣置换术（TVR）手术指征及方式，总结三尖瓣病变的手术治疗经验。方法2005年9月至2010年5月共施行TVR27例，其中置换生物瓣膜23例，机械瓣膜4例；同期行二尖瓣置换术8例，二尖瓣、主动脉瓣双瓣膜置换术4例，房间隔缺损修补术4例。结果手术病死率为11．1％（3／27），其中2例术后死于重度低心排血量综合征，1例术后第7天死于多器官功能衰竭。术后二次开胸止血1例，经积极治疗后顺利康复出院。随访率91．7％（22／24），1例术后3年死于生物瓣膜毁损，1例术后19个月死于脑栓塞。随访期间心功能NYHA分级恢复至I级6例，Ⅱ级14例。结论行TVR的患者中、远期病死率均较高，对于严重的三尖瓣病变患者，正确的手术方式、合理的围手术期处理是手术成功的关键。对于年龄大于50岁、随访不便以及未生育适龄女性患者来说，优先考虑置换生物瓣膜。Objective To analyze the medium and long-term results of tricuspid valve replacement （TVR） and summarize the operative experience for tricuspid valve disease. Methods Clinical data of 27 patients with severe tricuspid valve disease from September 2005 to May 2010 were retrospectively reviewed. Biological valve prosthesis was replaced in 23 patients,while mechanical valve prosthesis was replaced in 4 patients. Accompanying procedures included mitral valve replacement in 8 cases, mitral valve replacement and aortic valve replacement in 4 cases, and repair of atrial septal defect in 4 cases. Results The operative mortality was 11.1% （3/27） ,among these patients,2 cases died of serious low cardiac output syndrome, 1 case died of muhiorgan failure on the 7th day after operation, 1 case who underwent reoperation for hemorrhage postoperative was improved after treatment. During follow-up, 1 patient died of biological valve prosthesis dysfuncion 3 years after operation, 1 patient died of cerebral embolism 19 months after operation. Six cases were in New York Heart Association （NYHA） class I ,and 14 cases in NYHA class II during the period of follow-up. Conclusions Because operative and follow-up mortality is high,TVR is the last selection for the treatment of tricuspid valve disease. Appropriate operative technique and perioperative therapy are the key for clinical success. For those older than 50 years,follow-up inconvenience and reproductive-age female patients, biological valve prosthesis should be recommended as a preferential choice.

关 键 词：心脏瓣膜假体植入 风湿性心脏病 生物瓣膜 机械瓣膜 

分 类 号：R654.2[医药卫生—外科学]