4种成形术治疗二尖瓣前瓣脱垂效果分析  

Comparison of four techniques to repair anterior leaflet prolepses

作　　者：刘彤[1,2] 甘辉立[1,3] 张健群[1,3] 王胜洵[1,3] 周其文[1,3] 孔睛宇[1,3] 郑斯宏[1,3] 伯平[1,3] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心内科,北京市100029 [3]北京市心肺血管疾病研究所心外科,北京市100029

出　　处：《中华实用诊断与治疗杂志》2012年第11期1057-1059,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81070041);北京市科委首都临床特色应用研究项目(Z121107001012067;Z121107001012068)

摘　　要：目的评价应用腱索折叠、腱索转移、人工腱索、"缘对缘"缝合4种成形手术方式治疗二尖瓣前瓣脱垂(anterior leaflet prolapse,ALP)的治疗效果。方法 143例ALP患者,按手术方法分为腱索折叠组23例、腱索转移组68例、人工腱索组27例,"缘对缘"缝合组25例,建立Kaplan-Meier生存曲线,随访时间为1个月～18a。结果围术期死亡7例,晚期死亡10例,其中腱索折叠组3例,腱索转移组2例,人工腱索组3例,"缘对缘"缝合组2例;5a生存率腱索折叠组(70.0±18.2)%,腱索转移组(98.0±2.0)%,人工腱索组(86.8±9.2)%,"缘对缘"缝合组(91.7±7.9)%,腱索转移组与其他3组比较差异均有统计学意义(P<0.05);11例再次手术,5a免除再次手术率,腱索折叠组为(83.3±15.2)%,腱索转移组为(96.1±2.7)%,人工腱索组为100%,"缘对缘"缝合组为(90.9±8.7)%,腱索转移组与腱索折叠组比较差异有统计学意义(P<0.05)。结论腱索转移术的中长期生存率优于腱索折叠术、人工腱索、"缘对缘"缝合,腱索转移术在中长期免除再手术率方面优于腱索折叠术。Objective To compare the therapeutic effects of chordal transposition, chordal shortening, artificial chordal and edge-to-edge techniques to repair the anterior leaflet prolapses （ALP）. Methods A total of 143 cases of ALP, were divided into group A （chordal shortening, n= 23）, group B （chordal transposition, n= 68）, group C （artificial chordal, n = 27） and group D （edge-to-edge technique, n = 25）. KaplarrMeier survival curve was drawn. All patients were followed up from one month to 18 years. Results There were seven perioperative deaths. There were 3, 2, 2, and 3 late deaths in group A, B, C and D respectively. The five-year survival rate in group B （98.0±2.0）% was significantly higher than that in group A, CandD（（70.04-18.2）%, （86.8±9.2）% and （91.7±7.9）%） （P〈0.05）. Eleven patients received reoperation. The patients free from reoperation in 5 years accounted for （83. 3 ± 15. 2）%, （96.1±2.7）%, 100± and （90.9±8.7） % in group A, B, C and D, and there was a significant difference between group B and group A （P〈0.05）. Conclusion Chordal transposition has a higher middle and long-term survival rate than chordal shortening, artificial chordal and edge-to-edge techniques. Chordal transposition has a lower rate of reoperation rate than the chordal shortening.

关 键 词：二尖瓣 前瓣脱垂 成形术 治疗效果 

分 类 号：R654.2[医药卫生—外科学]