退行性二尖瓣关闭不全行二尖瓣成形术305例临床分析  

Clinical analysis of 305 patients undergoing mitral valve repair for degenerative mitral regurgitation

作　　者：李红岩[1] 韩劲松[1] 王辉山[1] 尹宗涛[1] 

机构地区：[1]沈阳军区总医院心血管外科,辽宁省沈阳市110016

出　　处：《中国心血管病研究》2016年第10期922-926,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结退行性二尖瓣关闭不全行二尖瓣成形术的治疗经验及手术疗效.方法 回顾性分析我院2005年10月至2015年10月进行二尖瓣成形术的退行性二尖瓣关闭不全患者305例,男性167例,女性138例,年龄43～78（50.28±10.50）岁,术前超声心动图显示二尖瓣返流量中度136例、中-重度108例、重度61例.在中度低温体外循环下根据二尖瓣病变Carpentier功能分型行二尖瓣成形术,术中改行二尖瓣置换术4例;同期行冠状动脉旁路移植术58例、三尖瓣成形术156例、Ⅲ型迷宫术18例.出院后进行随访,采用超声心动图观察心功能及二尖瓣返流程度.结果 全组围术期无死亡.术后出现窦性心动过缓15例（4.92％）,室上性心动过速30例（9.84％）,延迟性心脏压塞1例（0.03％）,永久起搏器植入1例（0.03％）.术后随访272例,随访率89.2％（272/305）,随访时间3个月至10年.随访期间,1例于术后13个月死于脑梗死,1例死于交通事故,余270例均存活.1例患者因二尖瓣关闭不全复发于术后36个月行二尖瓣置换术,1例患者因感染性心内膜炎于术后45个月行二尖瓣置换术.所有患者随访期间心脏功能均较术前明显改善,术后超声心动图示左心房内径[（37.21±8.65）mm比（45.68±7.24）mm]、左心室舒张期末内径[（48.08±6.25）mm比（62.30±6.56）mm]、左心室收缩期末内径[（35.16±6.37）mm比（40.24±5.12）mm]与术前相比明显缩小（P均＜0.05）,左心室射血分数明显提高（0.64±0.05比0.52±0.07,P＜0.05）.结论 根据退行性二尖瓣关闭不全的Carpentier分型,合理应用相应的成形方法,并熟练掌握相应的手术技巧,可获得良好的临床效果.Objective To evaluate the surgical outcomes and summarize clinical experience of patients with degenerative mitral regurgitation underwent mitral valve repair. Methods Clinical data of 305 patients with degenerative mitral valve regurgitation who underwent mitral valve repair from October 2005 to October 2015 in our hospital were retrospectively analyzed. There were 167 male patients and 138 female patients with their age of 43- 78（50.28±10.50）years. Echocardiography indicated that moderate mitral valve regurgitation in 136 patients, moderate to severe MR in 108 patients, and severe mitral valve regurgitation in 61 patients. All patients had the operation under standard cardiopulmonary bypass according to Carpentier＇ functional classification. 4 patients got mitral valve replacement. 58 patients underwent concomitant coronary artery bypass graft, 156 patients underwent concomitant tricuspid valvuloplasty, 18 patients underwent concomitant COX III. Echocardiography was used to evaluate heart function during follow-up. Results There was no in-hospital death in this group. Postoperative complications included sinus hradycardia in 15 patients, supraventrieular tachycardia in 30 patients, late cardiac tampenade in 1 patient, and permanent pacemaker implantation in 1 patient. 272 patients were followed up for 3 months to 10 years with a follow-up rate of 89.2%（272/305）. During follow-up, 1 died of cerebral embolism after 13 months discharge, 1 died from accident, while the remaining were alive. 1 patient gets mitral valve replacement because of MR in 36 months. 1 patient gets mitral valve replacement because of infectious endocarditis in 45 months. The echocardiography showed that postoperative left atrium diameter[ （45.68±7.24）mm vs （37.21±8.65）mm, P〈0.053, left ventricular end-diastolic diameter[ （62.30±6.56）mm vs （48.08±6.25）mm, P〈0.05] and left ventrieular endsystolic diameter[ （40.24±5.12）mm vs （35.16±6.37）mm, P〈0.05 ] were significantly decreased compared with that b

关 键 词：退行性病变 二尖瓣关闭不全 二尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]