改良Morrow手术治疗梗阻性肥厚型心肌病  

Surgical treatment with modified Morrow procedure in hypertrophic obstructive cardiomyopathy

作　　者：高长青[1] 任崇雷[1] 肖苍松[1] 吴扬[1] 王刚[1] 刘国鹏[1] 王瑶[1] 

机构地区：[1]解放军总医院心血管外科全军心脏外科研究所,北京100853

出　　处：《中华外科杂志》2012年第5期434-437,共4页Chinese Journal of Surgery

摘　　要：目的总结改良Morrow手术治疗梗阻性肥厚型心肌病（HOCM）的临床经验。方法2003年6月至2011年3月，采用改良Morrow手术治疗HOCM患者38例。其中男性26例，女性12例；年龄18-64岁，平均36．3岁。术前均经超声心动图及螺旋CT确诊HOCM，所有患者均可见中重度收缩期前运动（SAM），29例患者伴有不同程度的二尖瓣关闭不全。所有患者采用改良Morrow手术，其中9例将升主动脉完全离断，施行肥厚室间隔肌肉的彻底切除。术中经食管超声心动图（TEE）检测评估手术解除梗阻效果，术后1～2周内再次经胸超声心动图复查手术效果。随访时复查超声心动图。结果38例患者均治愈出院。术中TEE测量左心室流出道压差（14±11）mmHg（1mmHg：0．133kPa），较操作开始前（95±36）mmHg明显降低（t=13．265，P=0．000）。经胸超声心动图数据比较显示，术后室间隔厚度（12±3）mm，较术前（28±8）mm变薄（t=11．656，P=0．000）；左心室流出道压差（18±13）mmHg，较术前（89±31）mmHg降低（t=12．729，P=0．000）。二尖瓣关闭不全程度及SAM现象改善或消失（t=7．930，t：5．213，P均=0．000）。术后平均随访30个月，患者术前症状均明显减轻或消失，超声心动图示左心室流出道压差保持术后水平（t=0．688，P=0．494）。结论改良Morrow手术是治疗HOCM确切有效的方法；术中良好显露左心室流出道，彻底切除肥厚的室间隔是手术成功的关键。Objective To summarize the experience of ventricular septal myectomy （modified Morrow procedure） in patients with hypertrophic obstructive cardiomyopathy （ HOCM ）. Methods From June 2003 to March 2011, 38 patients （26 male and 12 female） with HOCM underwent modified Morrow procedure. The mean age was 36. 3 years （ ranging from 18 to 64 years ）. The diagnosis was made by echocardiography and spiral CT. The mean systolic gradient between the left ventricle and the aorta from transthroax echocardiography （TTE） was （89 ± 31 ） mmHg （ranging from 50 to 184 mmHg, 1 mmHg = 0. 133 kPa） before operation. There was moderate or severe systolic anterior motion （SAM） in 38 cases and mitral regurgitation in 29 cases. Ventricular septal myectomy with modified Morrow procedure was performedin all 38 cases. TEE was used intraoperatively to evaluate the results of the surgical procedures. After 1 to 2 weeks of operation, TTE was performed to evaluate the effect of operation. All patients were followed up with TI＇E after operation. Results All patients were discharged without complications. Intraoperative TEE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from （95 ±36） mmHg before procedures to （ 14 ±11 ） mmHg after operation （ t = 13. 265, P =0. 000）, and the thickness of ventricular septum was decreased from （28 ± 8 ） mm to （ 12±3 ） mm （ t = 11. 656, P = 0. 000）. TYE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from （89 ± 31 ） mmHg preoperatively to （ 18±13） mmHg （t = 12. 729, P =0. 000） in 1 to 2 weeks after operation. Mitral regurgitation and SAM were significantly improved or disappeared （t = 7.930, t = 5. 213, both P = 0. 000）. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only and syncope was abolished, and TIE showed that the pressure gradient was kept on the postoprational level or sli

关 键 词：心肌病 肥厚性 心肌成形术 

分 类 号：R542.2[医药卫生—心血管疾病]