“缘对缘”二尖瓣成形术治疗交界区脱垂在老年患者中的近中期效果  

The short and mid-term results of the edge-to-edge mitral valve repair for commissural prolapse in elderly patients

作　　者：张步升[1] 郑悦[1] 方亮[1] 戴黄栋[1] 朱丹[1] 孔烨[1] 

机构地区：[1]上海交通大学附属胸科医院心外科,上海200030

出　　处：《临床与病理杂志》2016年第9期1336-1339,共4页Journal of Clinical and Pathological Research

基　　金：上海市胸科医院科技发展基金(YZ14-05)~~

摘　　要：目的：评价在老年患者中“缘对缘”二尖瓣成形术治疗单纯交界区脱垂的近中期效果。方法：2012年4月至2015年4月,本中心对连续的32例单纯性二尖瓣交界区脱垂的老年患者（≥65岁）施行了二尖瓣成形术,并排除了冠心病、风湿性心脏病、感染性心内膜炎、原发性心肌病等导致的二尖瓣反流患者。其中男性20例,女性12例;年龄65-76岁,平均（68.4±2.8）岁。其中NYHA心功能Ⅱ级18例,Ⅲ级12例,Ⅳ级2例。本组患者手术均采用5-0 prolene缝线行二尖瓣交界区“缘对缘”缝合,闭合交界脱垂区域,且均植入二尖瓣成形环。结果：本组患者全部存活,随访12-48个月。患者术后心功能均明显改善（NYHA心功能Ⅰ级24例,Ⅱ级7例,Ⅲ级1例）。21例患者二尖瓣无或仅有微量反流,11例患者有轻度二尖瓣反流,无中度及以上二尖瓣反流,无SAM征。左心室舒张末期容积（left ventricular end diastolic volume,LVEDV）：术前为（158.2±28.6）mL,术后为（123.2±18.3）mL,术前与术后相比差异有统计学意义（P〈0.001）。结论：在老年患者中采用“缘对缘”二尖瓣成形术治疗单纯交界区脱垂,具有简单、有效、易操作的特点,缩短手术时间,且可获得良好和稳定的近中期效果。Objective： To evaluate the short and mid-term results of mitral valve repair by “edge-to-edge” technique in elderly patients with isolated commissural prolapse.Methods： Between Apr 2012 and Apr 2015, 32 consecutively elderly patients （≥65 years old） with isolated commissural prolapse underwent mitral valve repair in the unit, and the patients with coronary artery disease, rheumatic heart disease, infectious endocarditis or primary myocardiopathy were excluded. In the study, 20 male and 12 female were included, and the mean age was （68.4±2.8） years （range, 65-76 years）. Eighteen patients were in New York Heart Association classⅡ, 12 patients in classⅢ, two patients in classⅣ. The technique used in the operations was surgical closure of the diseased commissure by edge-to-edge repair with 5-0 prolene suture, and mitral annuloplasty was performed routinely with annuloplasty ring in all patients.Results： All patients survived, and were followed up from 12 to 48 months. hTe patients had their cardiac function improved apparently （24 patients were in New York Heart Association classⅠ, 7 patients in classⅡ, 1 patients in classⅢ）. hTere was no or trivial mitral valve regurgitation in 21 patients, mild regurgitation in 11, and moderate regurgitation or above in none. Letf ventricular end diastolic volume （LVEDV） was reduced signiifcantly, （158.2±28.6） mL preoperatively vs. （123.2±18.3） mL postoperatively （P〈0.001）.Conclusion： With “edge-to-edge” technique in elderly patients, mitral valve repair for commissural prolapse was simple, effective and reproducible. It could greatly decrease the operation time and obtain stable and excellent results.

关 键 词：“缘对缘”技术 二尖瓣脱垂 二尖瓣成形术 老年 

分 类 号：R654.2[医药卫生—外科学]