Ebstein心脏畸形27例外科治疗分析  

Clinical anatomy and surgical treatment of Ebstein＇s anomaly

作　　者：刘高利[1] 马黎明[1] 郑善光[1] 李祥[1] 程前进[1] 李庆臣[1] 赵永亮[1] 

机构地区：[1]济宁医学院附属医院心脏外科、山东省心脏疾病诊疗重点实验室,272029

出　　处：《临床外科杂志》2012年第3期175-176,共2页Journal of Clinical Surgery

摘　　要：目的总结Ebstein心脏畸形的临床解剖特点与外科治疗经验。方法2006年2月至2011年2月手术治疗27例Ebstein畸形的患者，行单纯三尖瓣环成形术1例，行Danielson式折叠术5例，Carpentier式折叠术21例，其中5例患儿三尖瓣功能右心室发育差，加行双向Glenn术，2例心声见三尖瓣微量至轻度反流23例，中度反流4例。术后25例随访2个月-4年，平均（3．3±1．6）年，随访期间右心功能衰竭死亡1例；再次手术行三尖瓣置换1例；余23例心脏复跳后三尖瓣瓣叶关闭不良，大量反流，再次阻断行三尖瓣置换术。结果全组无手术死亡；术后1-2周复查心脏超功能I级16例，Ⅱ级5例，Ⅲ级2例。结论Ebstein畸形的患者三尖瓣修复是一项有效的手术，术中应根据患者的临床解剖特点，选择合适的手术方法，可有效地缓解患者的临床症状，提高患者的生活质量。Objective To summarize the surgical experience of Ebstein ＂s anomaly. Methods Twenty-seven Ebsteing anomaly patients aged from 3 years 1 month to 40 years with an average of （ 17 ± 3.5 ） years underwent operation from February 2006 to February 2011. One patient was treated with simple tricuspid valvuloplasty,5 with Danielson plication of atrialized right ventricle, 16 with Carpentier method, including bidirectional Glenn operation in 5 due to the poor function of right ventricular, and reoperation of mitral valve replacement in one because of mitral valve repair failure. Results No patient died from operation. The transesophageal echocardiology showed minimal to mild tricuspid regurgitation in 23 patients, and moderate tricuspid regurgitation in 4 patients after 1 to 2 weeks from operation. Twenty-five patients were followed up for 2 months to 4 years with an average of 3.3 ± 1.6 years, in which 1 patient died from right ventricular failure,and 1 patient received reoperation of mitral valve replacement;In the remaining, the cardiac function was NYHA I in 16 patients,NYHA II in 5 and NYHA HI in 2. Conclusion Tricuspid valve repair is an effective method for Ebsteing anomaly. It can alleviate patients＇clinical manifestations, provide better hemodynamics, help the recovery of right ventricular function and improve the quality of life.

关 键 词：心脏缺损 先天性 三尖瓣 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]