硬质三维三尖瓣成形环的临床应用研究  

Clinical Application of Three-dimensional Rigid Tricuspid Annuloplasty Ring

作　　者：赵亮[1] 彭晓波[2] 陈劲进[2] 翟建宾[1] 范子盼 肖颖彬[2] ZHAO Liang;PENG Xiao-bo;CHEN Jin-jin;ZHAI Jian-bin;FAN Zi-pan;XIAO Ying-bin(Department of Cardiothoracic Surgery,Bethune International Peace Hospital of PLA,Shijiazhuang 050082,China;Department of Cardiovascular Surgery,the Second Affiliated Hospital of Third Army Medical University,Chongqing 400037,China)

机构地区：[1]解放军白求恩国际和平医院心胸外科,石家庄050082 [2]第三军医大学第二附属医院心外科,重庆400037

出　　处：《临床误诊误治》2018年第9期38-41,共4页Clinical Misdiagnosis & Mistherapy

基　　金：2015年度河北省医学科学研究重点课题计划项目(20150006)

摘　　要：目的采用不同方法选择MC3硬质三维三尖瓣成形环的型号,探讨重度功能性三尖瓣关闭不全的个体化治疗方案。方法选取我院2013年10月—2014年6月收治的左心系统瓣膜疾病并重度三尖瓣关闭不全64例,按照随机数字表法分为观察组及对照组,每组各32例。观察组采用测量器测量三尖瓣前瓣面积以确定人工硬质三维成形环型号,对照组评估患者体表面积、右心房室的大小及三尖瓣瓣环径选择相应的人工硬质三尖瓣成形环,记录两组临床疗效。结果 64例均成功行二尖瓣置换术并三尖瓣成形术,术中三尖瓣反流试水试验均无明显反流,术后无房室传导阻滞、冠状动脉损伤或主动脉根部损伤等并发症发生,均痊愈出院。两组术前三尖瓣反流均为重度,术后反流程度及反流面积明显改善。与对照组比较,观察组术后反流面积明显缩小,差异有统计学意义(P<0.05)。结论术中采用测量器测量三尖瓣前瓣面积以确定成形环型号,术后三尖瓣反流面积更小,更有利于实现功能性三尖瓣关闭不全的个体化治疗。Objective To determine the size of Edward MC3 three-dimensional （3-D） rigid tricuspid annuloplasty ring by different measuring methods, and to explore the individualized surgical treatment of severe functional tricuspid regurgitation. Methods From October 2013 to June 2014, 64 patients with left ventricular valvular disease combined with severe functional tricuspid regurgitation were treated in our hospital. They were selected and randomly divided into two groups according to the random number table： observation group and control group, with 32 cases in each group. In observation group, the size of annuloplasty ring was decided by measuring the area of anterior tricuspid valve with a measuring device. By contrast, in control group, the corresponding artificial 3-D rigid tricuspid annuloplasty ring was selected according to the patient＇s body surface area, the size of the right atrium and the diameter of tricuspid valve ring. The postoperative curative effect was compared and analyzed. Results All 64 patients successfully underwent mitral valve replacement and tricuspid annuloplasty. There was no obvious regurgitation in tricuspid regurgitation test during the operation. And there were no postoperative complications such as atrioventricular block, coronary artery injury or aortic root injury. All of them were discharged from the hospital after recovery. Preoperative tricuspid regurgitation was severe in the two groups, and the degree and the area of the tricuspid regurgitation were all significantly reduced after operation in both groups. The area of postoperative tricuspid regurgitation was significantly smaller in observation group than in control group, suggesting significant differences （ P 〈0.05）. Conclusion The area of anterior tricuspid valve was decided with a measuring device during the operation to determine the size of the annuloplasty ring. Therefore, the area of postoperative tricuspid regurgitation was smaller, which may be more beneficial for the individualized surgical treatment o

关 键 词：三尖瓣闭锁不全 心脏瓣膜成形术 疗效比较研究 

分 类 号：R542.43[医药卫生—心血管疾病]