108例二尖瓣闭式扩张术后再狭窄的外科治疗  

Surgical Treatment for Mitral Restenosis after Closed Mitral Commissurotomy: An Analysis of 108 Cases

作　　者：郑家豪[1] 朱洪生[1] 黄日太[1] 梁保罗[1] 富皓白[1] 梁而慷[1] 殷荣[1] 

机构地区：[1]上海第二医科大学仁济医院胸心外科,上海200001

出　　处：《上海第二医科大学学报》2001年第5期437-439,共3页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的总结 10 8例二尖瓣闭式扩张术后再狭窄病人的再手术治疗围术期处理经验。　方法 10 8例二尖瓣闭式扩张术后再狭窄病人首次术式经左径扩张 94例 ,右径 12例 ,左右径 2例。术前心功能II级 42例 ,III级5 2例 ,IV级 14例。再次手术行二尖瓣置换 (MVR) 6 7例 ,MVR +三尖瓣成形 (TVP) 2 2例 ,二尖瓣主动脉瓣双瓣置换(DVR) 13例 ,DVR +TVP 3例 ,MVR并其它术式 3例。　结果术中死亡 3例 ,术后早期死亡 6例 ,占 8.3% ;术后发生并发症 2 6例 ,占 2 4.1%。术前心功能III～IV级的死亡与并发症的发生率较心功能II级者有明显差异 (P <0 .0 1)。　结论二尖瓣闭式扩张术后再狭窄病人需尽早行手术治疗 ;术前正确评价和改善心肺功能 。Objective To summarize the experience of reoperation and perioperative treatment of patients with mitral restenosis after closed mitral commissurotomy (CMC). Methods Among 108 patients with closed mitral commissurotomy (CMC) the primary procedure had been performed via left thoracotomy in 94 cases, while right thoracotomy in 12 and bilateral thoracotomy in 2. The cardiac function (CF) before reoperation was class II in 42 cases, class III in 52 and class IV in 14. Reoperations included mitral valve replacement (MVR) in 67 cases, MVR plus tricuspid valve plasty (TVP) in 22, double valve replacement (DVR) in 13, DVR plus TVP in 3 and other procedures in 3 cases. Results There were 3 deaths during operation and 6 early after operation. The overall mortality was 8.3%. 26 complications occurred after operation (24.1%). The mortality and incidence of complications in patients with CF over class III were higher than those with class II CF (P<0.01). Conclusion Reoperation should be prompt when necessary. Cardiac and lung function should be evaluated and improved before operation. Cardiac protection and prevention of complications are also stressed.

关 键 词：二尖瓣闭式扩张术 再狭窄 再手术 围术期处理 外科手术 

分 类 号：R654.2[医药卫生—外科学]