功能性三尖瓣关闭不全不同成形方法的中远期效果观察  

Mid-long-term effect of different plasty for functional tricuspid valve regurgitation

作　　者：葛振伟[1] 程兆云[1] 王保才[1] 胡俊龙[1] 赵子牛[1] 乔刚[1] 权晓强[1] 张国报[1] 

机构地区：[1]河南省人民医院心血管外科,河南郑州450003

出　　处：《新乡医学院学报》2016年第6期492-496,共5页Journal of Xinxiang Medical University

摘　　要：目的总结单纯缝线瓣环成形术和置入人工成形环的三尖瓣成形方法治疗功能性三尖瓣关闭不全(TR)的临床中、远期效果。方法合并左心系统瓣膜病变的功能性TR患者677例,其中行左心瓣膜手术包括二尖瓣置换(MVR)356例、二尖瓣成形(MVP)98例、MVR+主动脉瓣置换(AVR)181例,冠状动脉旁路移植(CABG)+MVR 15例,CABG+MVP 27例,所有患者均与左心瓣膜手术同期行三尖瓣成形术,其中353例采用单纯缝线瓣环成形术(非上环组),324例置入人工成形环(上环组);术后随访观察患者的临床及心脏超声随访资料。结果完成术后2 a随访者,非上环组348例,上环组317例;其中三尖瓣中度及以下TR者,非上环组为286例(82.2%),上环组为294例(92.7%),2组比较差异无统计学意义(P=0.370);发展为重度TR者,非上环组为62例(17.8%),上环组为23例(7.3%),非上环组发展为重度TR者比例显著高于上环组(P=0.031)。术后随访5 a,非上环组有5例患者因顽固性心力衰竭再入院,心脏超声提示重度TR,其中3例心力衰竭治疗无效死亡,2例再行三尖瓣置换治愈出院;上环组无顽固性心力衰竭和再次心脏手术病例。完成术后5 a随访者,非上环组308例,上环组292例,其中心脏彩色超声检查示非上环组轻度以下TR者34例(11.0%),中度TR者185例(60.1%),重度TR者89例(28.9%);上环组轻度以下TR者73例(25.0%),中度TR者190例(65.1%),重度TR者29例(9.9%);上环组轻度以下TR者比例显著高于非上环组(P=0.029),重度TR者比例显著低于非上环组(P=0.007),2组之间中度TR者比例比较差异无统计学意义(P=2.190)。与随访2 a结果相比较,非上环组完成5 a随访者重度TR发生率明显增加(28.9%vs 17.8%,P=0.022),而上环组完成5 a随访者重度TR发生率与随访2 a结果相比较差异无统计学意义(9.9%vs 7.3%,P=0.520)。结论对于功能性TR的处理应采取更加积极的态度,尽量采用人工瓣环置入的方法进行三尖瓣缩环,以代替单纯缝�Objective To compare the mid- and long-term effect of tricuspid valve（ TV） plasty with simple sutures or with an implanted annuloplasty ring for functional tricuspid valve regurgitation（ TR）. Methods Six hundred and seventy-seven patients with TR underwent TV repair of which 356 patients were given mitral valve replacement（ MVR）,98 cases were performed with mitral valve plasty（ MVP）,181 cases were treated with MVR and aortic valve replacement,15 cases were given coronary artery bypass grafting（ CABG） and MVR,27 cases were performed with CABG and MVP. All the patients were given left cardiac valve surgery and at the same time tricuspid valvoplasty were given. Of all the patients,353 patients were given simple sutures annuloplasty and 324 cases were given implanted annuloplasty ring. Clinical and echocardiographic follow-up data were obtained. Results There were 348 cases in non-ring group（ group N） and 317 cases in ring group（ group A） who completed 2-year follow-up. There were 286 cases（ 82. 2%） with mild or moderate TR in group N,while there were 294 cases（ 92. 7%） in group A. There was no significant difference in the incidence of mild or moderate TR between the two groups（ P = 0. 370）. But the cases that developed into severe TR in group N（ 62 cases,17. 8%） were significantly more than group A（ 23 cases,7. 3%）（ P = 0. 031）. The 5-year follow-up revealed that group N had five cases of re-hospitalization due to intractable heart failure,and ultrasound prompted the results of severe TR,among the patients three cases died of heart failure and two cases were re-performed the tricuspid valve replacement and discharged after cured. There was no case with intractable heart failure and re-hospitalization in group A. There were 308 cases in group N and 292 cases in group A who completed 5-year follow-up. The color Doppler ultrasound showed that there were 34 cases（ 11. 0%） with mild TR,185 cases（ 60. 1%） moderate TR,89 cases（ 28. 9%） with severe TR in group

关 键 词：三尖瓣关闭不全 三尖瓣成形术 人工成形环 

分 类 号：R654.2[医药卫生—外科学]