保留瓣叶及瓣下结构的二尖瓣置换术  

Mitral Valve Replacement With Preservation of Leaflet and Subvalvular Structure

作　　者：林链凤[1] 邱明义[1] 吴健[1] 高翔[1] 

机构地区：[1]福建省龙岩市第一医院心胸外科,364000

出　　处：《齐齐哈尔医学院学报》2000年第2期131-132,共2页Journal of Qiqihar Medical University

摘　　要：目的 :探索二尖瓣置换术方法与早期临床效果的关系 ,对 40例二尖瓣置换术患者保留瓣叶及瓣下结构法与切除瓣叶及瓣下结构法进行对比研究。方法 :保留瓣叶及瓣下结构法和切除瓣叶及瓣下结构法二尖瓣置换术各 2 0例 ,分别对手术死亡率 ,术后多巴胺用量和持续时间 ,术后心功能恢复情况进行对照分析。保留组全部用连续缝合固定人工瓣 (大部分为兰州单叶机械瓣 )。部分保留 14例为二尖瓣狭窄为主 ,完全保留 6例为二尖瓣关闭不全。结果 :保留组术后无死亡 ,切除组术后左心室功能恶化死亡 1例。与切除组相比 ,保留组术后多巴胺用量小 ,持续时间短 ,心功能恢复好。完全保留者术后恢复尤为顺利。结论 :二尖瓣置换术应尽量保留瓣叶与瓣下结构。二尖瓣关闭不全者应行瓣中瓣植入术。连续缝合法和国产单叶机械瓣同样适用于部分或完全保留术。Objective:This study was amied to study the early results of preservation of leaflet and subvalvular structure in mitral valve replacement(MVR). Method: 40 cases of MVR were divided into two groups, preservation(20 cases), and resection(20 cases) of the leaflet and subvalvular structure. Between two groups the operative mortality, the speed and duration of Dopamine and the recovery of heart function after operation were comparatively analyzed. Continuous stitch to fix the prothesis was used in all cases of the perservation group, in which 14 cases with mitral stenosis were partial preservation and 6 cases with mitral insufficience were entire preservation(intro-valvular inplantation). Most of the artificial prothesis inplantated were made in Lanzhou. Results: All cases of the preservation group recovered from their illness. One patient of the resection group died of sever postoperative low cardiac ourput. Comparing one with another by 'T' method, we found that Dopamine was used in less patients, lower speed and less duration in the preservation group than in the resection one (P<0.01). The recovery of heart function after operation is sooner and better in the preservation group than in the resection one (P<0.01). Conclusions: The authors suggest that all patients with mitral insufficience should receive MVR with entire preservation of the lealfet and subvalvular structure and those with mitral stenosis should receive MVR with posterior lealfet and subvalvular structure preservation. Continous stitch to fix the prothesis is simple and safe. The prothesis made in Lanzhou is also suitable for the preservation group.

关 键 词：二尖瓣置换术 保留瓣叶及瓣下结构 心功能 

分 类 号：R654.2[医药卫生—外科学]