全胸腔镜人工腱索二尖瓣成形术的近期结果  

Early outcomes of totally endoscopic mitral valve repair with artificial chordae implantation

作　　者：朱任 黄焕雷[1] 刘健[1] 郭惠明[1] 谢斌[1] 柯英杰 曾庆诗[1] 卢聪[1] 

机构地区：[1]广东省心血管病研究所广东省华南结构性心脏病重点实验室广东省人民医院广东省医学科学院,广州510080

出　　处：《中国胸心血管外科临床杂志》2017年第10期787-790,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省公益研究与能力建设项目(2014A020209050);广东省自然科学基金项目(2016A030313799)

摘　　要：目的评价全胸腔镜二尖瓣成形的手术效果,介绍腔镜下人工腱索构建的个人经验与体会。方法回顾性分析2013年5月至2016年6月体外循环下行全胸腔镜人工腱索二尖瓣成形术71例二尖瓣关闭不全患者的临床资料,其中男47例、女24例,年龄13~78(46.1±14.5)岁。患者病因包括退行性瓣膜病63例,先天性瓣膜病变4例,感染性心内膜炎2例,风湿性瓣膜病1例,心肌病1例。前瓣病变26例,后瓣19例,前后瓣25例,以瓣环扩大为主1例;合并交界区病变13例。二尖瓣反流面积4.2~26.3(12.2±5.6)cm2。手术均在全胸腔镜心脏停跳下进行,以5-0 Gore-tex线为人工腱索材料,均采用逐一单根植入的方法构建人工腱索。结果瓣膜成形转瓣膜置换1例,术中转正中开胸止血1例,无住院死亡病例。体外循环时间(156.0±31.6)min,主动脉阻断时间(110.0±20.1)min。单纯二尖瓣成形39例,二尖瓣成形+三尖瓣成形28例,二尖瓣成形+房间隔缺损修补3例,二尖瓣成形+部分型肺静脉异位引流矫治1例。平均每例患者植入人工腱索1~7(2.5±1.7)根,65例植入二尖瓣成形环。术中经食管超声检查,无反流44例,反流面积0~2 cm2 24例,反流面积>2 cm2 3例。反流面积>2 cm2的3例患者均有明显的二尖瓣前叶收缩期前向运动(SAM)征,再次阻断主动脉行瓣膜置换1例,再次成形1例,另1例保守治疗。随访1~36(12.7±10.5)个月,失访2例,随访率97.2%。重度反流3例,中度反流5例,轻度或轻微反流27例,未见二尖瓣反流36例。随访期间死亡1例,脑梗死1例,无再次手术病例。结论全胸腔镜下采用单根植入法行人工腱索二尖瓣成形可获得良好效果,其难点在于如何确定腱索长度及保持这一长度的稳定性。Objective To evaluate the outcomes and summarize the clinical experience of totally endoscopic mitral valve repair with artificial chordae implantation. Methods From May 2013 to June 2016, 71 patients with mitral valve insufficiency were admitted to our hospital who underwent totally endoscopic mitral valve repair with artificial chordae implantation. There were 47 males and 24 females with the age of 46.0±14.4 years ranging from 13-78 years. The pathogenesis included degenerative valvular diseases in 63 patients, congenital valvular diseases in 4, infectious endocarditis in 2, rheumatic disease in 1 and cardiomyopathy in 1. Prolapse of anterior, posterior, or both leaflets was present in 26 （36.6%）, 19 （26.8%）, and 25 （35.2%） patients, respectively; one patient （1.4%） presented valve annulus enlargement and thirteen were associated with commissure lesion. The mitral regurgitation area ranged from 4.2 to 26.3 cm^2 （mean, 12.2±5.6 cm^2）. All the procedures were performed by total endoscopy under cardiac arrest. 5-0 Gore-rex sutures were used as the material of artificial chordae which was implanted one by one. Results There was no in-hospital death. One patient was transferred to mitral valve replacement, and one median sternotomy due to bleeding. The mean cardiopulmonary bypass time was 156.0±31.6 min and aortic cross-clamp time 110.0±20.1 min. We finally had 39 isolated mitral valve repair, 28 mitral valve repair combined tricuspid valve repair, 3 mitral valve repair combined atrial septal defect closure, and 1 mitral valve repair combined correction of partial anomalous pulmonary vein connection. Each patient was implanted artificial chordae of 2.5±1.7 （ranging from 1 to 7）, and 65 patients received mitral annulus （full ring）. The intraoperative transoesophageal echocardiography found no mitral regurgitation in 44 patients, the area of mitral regurgitation was 0-2 cm^2 in 24, and 3 patients with mitral regurgitation〉2 cm^2 experienced serious systolic anterior motion. Of the 3

关 键 词：全胸腔镜手术 二尖瓣成形 人工腱索 

分 类 号：R654.2[医药卫生—外科学]