圆锥法矫治三尖瓣下移畸形的近中期效果  

Early and midterm results of Ebstein′s anomaly with the treatment :the cone reconstruction for the tricuspid valve

作　　者：曹一秋[1] 邢杰[1] 李儒正[1] 张红[1] CAO Yiqiu;Xing Jie;LI Ruzheng;ZHANG Hong(Department of Cardiac Surgery,Hainan General Hospital,Haikou 570013,China)

机构地区：[1]海南省人民医院心脏外科,海口市570311

出　　处：《实用医学杂志》2017年第12期1948-1952,共5页The Journal of Practical Medicine

基　　金：2015海南省应用技术研发与示范推广专项重点项目(编号:ZDXM2015074)

摘　　要：目的:通过探讨圆锥法矫治三尖瓣下移畸形,总结其早、中期临床效果。方法:2012年1月至2016年6月我院应用圆锥法矫治三尖瓣下移畸形16例,其中男7例、女9例,平均(28.21±11.88)岁,Carpentier B型12例、C型4例,心功能Ⅱ级2例、Ⅲ级9例,Ⅳ级5例,三尖瓣反流2级2例、3级10例、4级4例,通过分析其临床资料,观察早、中期效果。结果:住院及随访过程中无死亡,其中1例术后第1天出现低心排血综合征、1例术后第3天出现室早二联律,经治疗后好转,均恢复顺利,出院时三尖瓣反流由术前的(3.13±0.62)级下降到(1.75±0.45)级(P<0.001),心功能由术前的(3.19±0.66)级提高至(2.00±0.52)级(P<0.001),平均随访(24.36±10.71)个月,较出院时三尖瓣反流进一步下降至(1.31±0.48)级(P=0.016),心功能提高至(1.50±0.52)级(P=0.031)。结论:圆锥法矫治三尖瓣下移畸形能够有效改善三尖瓣功能、右室几何形态及心功能状态,提高患者生活质量,取得满意的早、中期效果,但仍需扩大病例数及严格掌握适应证,远期效果尚需进一步观察。Objective To evaluate the early and midterm effect by retrospective analysis of the conereconstruction in Ebstein′s anomaly.Methods From January2012through June2016,16patients with Ebstein′sanomaly underwent the cone reconstruction in our hospital.There were7males and9females at mean age(28.21±11.88)years,including12patients of Carpentier B type,4patients of Carpentier C type.There were9patients inNew York Heart Association(NYHA)functional classⅢ,5patients in NYHA functional classⅣand the othersin NYHA functional classⅡ.All patients had Tricuspid insufficiency,including2patients with Grade2,10patients with Grade3and4patients with Grade4.All patients were followed up over a period of6to51months(mean:24.36±10.71).By comparing the details of pre?operation with post?operation and post?operation withcurrent stage,we analyze the outcomes of early and midterm effects.Results All patients are well survived.Therewere one patient recovering from the low cardiac output syndrome with adding the strength of the positive inotropicdrug in the first day after operation,and one patient recovering from bigeminy of ventricular prematurebeat with theaid of amiodarone and lidocaine the third day after operation.The remaining patients recovered smoothly.Early postfrom(3.13±0.62)to(1.75±0.45)(P<0.001)with the functional class improved from(3.19±0.66)to(2.00±0.52)(P<0.001).After mean follow?up of(24.36±10.71)months,the situation is improving furtherly with thetricuspid regurgitation grade reducing to(1.31±0.48)(P=0.016)and the functional class rising to(1.50±0.52)(P=0.031).Conclusions This surgical technique for Ebstein′s anomaly can improve the function of tricuspidvalve and the right ventricular morphology.It showed a satisfactory performance in the early and midterm results byenhancing the Cardiac function and life quality.But indications should be strictly grasped and more experiencesneed to be accumulated.Long?term effect need to be furtherly explored.

关 键 词：EBSTEIN 畸形 圆锥法重建 三尖瓣修复 

分 类 号：R654.2[医药卫生—外科学]