乳头肌或人工腱索移植治疗外伤性三尖瓣关闭不全的研究  

The study of treatment with papillary muscle or artificial tendineae grafting in patients with traumatic tricuspid regurgitation

作　　者：郭晓东 赵科研[2] 尹宗涛[2] GUO Xiao-dong;ZHAO Ke-yan;YIN Zong-tao(Department of Cardiovascular Surgery, General Hospital of Shenyang Military District, Shenyang 110016, China)

机构地区：[1]锦州医科大学沈阳军区总医院培养基地,辽宁省沈阳市110016 [2]沈阳军区总医院心血管外科

出　　处：《中国心血管病研究》2018年第6期539-541,共3页Chinese Journal of Cardiovascular Research

基　　金：2015年辽宁省自然科学基金项目(项目编号:2015020421)

摘　　要：目的： 探讨外伤性三尖瓣关闭不全的外科治疗方法及其手术效果。方法： 回顾分析2012年1月- 2016年12月收治的8例外伤性三尖瓣关闭不全外科手术治疗的临床病例。6例为交通事故所致车祸伤,2例有骤然用力史。手术距受伤时间1-24个月，其中三尖瓣前叶腱索断裂4例, 前乳头肌撕脱2例，前、后乳头肌撕脱1例, 后叶、隔叶腱索断裂1例。结果：2例行三尖瓣置换术（生物瓣），3例行三尖瓣人工腱索移植，3例前乳头肌重新固定。无手术死亡。出院前超声心动图检查成形的6例显示三尖瓣血流无返流2例,微量反流4例。术后随访, 随访时间2-24个月, 超声心动图检查成形的患者显示三尖瓣血流无返流3例,微量反流2例,少-中量反流1例。结论：外伤性三尖瓣关闭不全,应当尽早明确诊断并治疗。三尖瓣乳头肌重新固定及人工腱索固定到室间隔加瓣环成形术, 多能获得满意的治疗效果。Objective To investigate the surgical results of traumatic tricuspid regurgitation. Methods 8 cases of traumatic tricuspid regurgitation were analyzed retrospectively from January 2012 to December 2016. 6 cases were caused by traffic accidents, and 2 cases had a history of sudden and vigorous actor. The operation was performed 1 to 24 months after the injury. There were tendon rupture of the anterior lobe in 4 cases,anterior papillary muscles rupture in 2 cases,both the anterior and posterior papillary muscles rupture in one case, and the posterior lobe rupture in one case. Results 2 cases underwent tricuspid valve replacement, 3 cases underwent artificial tendineae grafting, the other 3 cases underwent anterior papillary muscle refixation.No patient died. 6 cases of tricuspid valve plasty with tricuspid regurgitation,no tricuspid regurgitation were detected in 2 cases, and trace TR were found in the other 4 cases. 2 to 24 months after the operation, echocardiographic indicated that 3 cases had no tricuspid regurgitation, 2 cases were trace TR, and 1 case had tricuspid regurgitation（mild-moderate）. Conclusion Traumatic tricuspid regurgitation should be diagnosed and treated early. A satisfactory result was achieved with the refixation of the ruptured papillary muscles and（or） the artificial tendinous cord to the ventricular septum.

关 键 词：外伤性 三尖瓣关闭不全 外科手术 三尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]