部分和全部保留瓣下结构二尖瓣置换术治疗巨大左心室患者临床比较研究  

Clinical comparison of mitral valve replacement with partial and complete preservation of subvalvular apparatus in treatment of giant left ventricle

作　　者：王俊东 崔勇 王建国 李虎 代金灿 马厚营 

机构地区：[1]云南省大理白族自治州人民医院心胸外科,云南大理671000

出　　处：《中国现代医生》2016年第15期30-33,共4页China Modern Doctor

摘　　要：目的 探讨仅保留后瓣及瓣下结构以及保留前、后瓣及瓣下结构两种术式治疗巨大左心室患者后对患者心功能的影响。方法 选择2004年1月~2013年6月我院共进行二尖瓣置换术治疗巨大左心室患者210例,根据治疗方法的不同将患者分为保留前、后瓣膜及瓣下结构125例（A组）,单纯保留后瓣及瓣下结构患者85例（B组）。分别于术后6个月、12个月和24个月心脏彩超检测患者心脏指数并比较分析。结果 本组所有患者均得到随访,随访时间为24个月,随访时间段内所有患者均没有发生瓣周漏和瓣膜功能障碍;彩超结果比较,术后6个月、12个月A组患者LVEF、LVFS、LVDD、LVSD、LVPWT和LVL均优于B组,但差异没有统计学意义（P〉0.05）,术后24个月,A组在LVEF、LVSD以及LVL三个指数均明显好于B组（P〈0.05）。结论 对于巨大左室患者,手术中应尽可能保留其全部瓣下结构,这对患者术后左心室形态和功能具有明显的促进作用。Objective To discuss and analyze the effects of two methods： preservation of posterior valve and subvalvular apparatus vs. preservation of anterior valve, posterior valve and suhvalvular apparatus, on cardiac function of patients with giant left ventricle. Methods 210 cases of mitral valve replacement were conducted from January 2004 to June 2013 in our hospital for treatment of giant left ventricle. The patients were divided based on different methods of opera- tion into group A （125 cases, with preservation of anterior valve, posterior valve and subvalvular apparatus） and group B （85 cases, with preservation of posterior valve and subvalvular apparatus）. Cardiac color ultrasound was conducted at 6 months, 12 months, and 24 months after operation to detect and compare the cardiac indexes of patients. Results All patients were followed up for 24 months, during which no perivalvular leakage or valve dysfunction was observed. The results of cardiac color ultrasound showed that at 6 and 12 months after operation, LVEF, LVFS, LVDD, LVSD, LVPWT, and LVL in group A were superior to those in group B, but without significant difference; at 24 months after operation, the LVEF, LVSD, and LVL in group A were significantly superior to those in group B （P〈0.05）. Conclusion For patients with giant left ventricle, subvalvular apparatus should he preserved as completely as possible, which has significant benefit for left ventricular conformation and function after operation.

关 键 词：巨大左心室 瓣下结构二尖瓣置换术 左心室功能 左心室形态 

分 类 号：R654.2[医药卫生—外科学]