自体心包片重建瓣环技术在重症瓣膜病外科手术中的应用  

The reconstruction technique of the valve annulus with autologous pericardial in surgical operation of severe valvular disease

作　　者：刘浪[1] 曹勇[1] 陈凯明[1] 赖锋华[1] 林世廷[1] 朱伯卫[1] 罗统波 LIU Lang;CAO Yong;CHEN Kai-ming;LAI Feng-hua;LIN Shi-ting;ZHU Bo-wei;LUO Tong-bo(Department of Cardiovascular Surgery,the People’s Hospital of Gaozhou city,Gaozhou 525200,China)

机构地区：[1]高州市人民医院心血管外科,广东省高州市525200

出　　处：《中国心血管病研究》2020年第2期127-130,共4页Chinese Journal of Cardiovascular Research

基　　金：广东省茂名市科技计划项目(2017090)。

摘　　要：目的总结心脏瓣环结构重建的手术方法和临床经验,探讨采取自体心包片重建心脏瓣环技术在重症瓣膜病外科手术中的应用和疗效.方法2016年1月至2019年5月在我院接受心脏瓣膜置换且同期需行瓣环结构重建的手术病例23例,其中风湿性或老年性退行性钙化性瓣膜病变的钙化斑累及瓣环结构13例,感染性心内膜炎侵蚀瓣环结构6例,先天性主动脉根部瓣环发育不良4例.其中清除侵蚀瓣环结构的异常组织后,瓣环位置的缺损样病变采取自体心包片予prolene线连续缝合修补重建瓣环结构;先天性主动脉瓣环发育不良者施行瓣环切除心包片修补瓣环扩大重建术及瓣膜置换术.结果术后早期肺部感染3例,急性肾功能衰竭2例,Ⅱ度Ⅰ型房室传导阻滞1例,均经治疗后痊愈.全组手术重建的心脏瓣环结构完整,血流动力学稳定,无死亡病例,均获满意的治疗效果.随访0.5~3.5年,近中期无心脏破裂穿孔、组织溶血、瓣周漏、血栓形成、心内膜炎感染复发等并发症.结论心脏瓣膜手术同期采取自体心包片重建瓣环技术安全可靠、方便易行、经济实惠,并发症少,手术效果满意.Objective To summarize the surgical method and clinical experience o f the reconstruction of the cardiac valve annulus and to explore the application and effect of the cardiac valve annulus reconstruction with autologous pericardial in surgical operation of severe valvular disease.Methods From January 2016 to May 2019,twenty-three patients undergone reconstruction of the annulus during the valve replacement in our hospital were enrolled.There were 13 cases of rheumatic or senile valvular degeneration with calcified plaques involved the annulus structure,6 cases of infective endocarditis eroded the annulus structure,4 cases of the congenital aortic ring dysplasia.After the abnormal tissue that eroded the annulus structure removed,the reconstruction was done with autologous pericardium by continuous prolene suture;the valve annulus resection and valve annulus expansion reconstruction during the valve replacement were performed in patients with congenital aortic annulus dysplasia.Results Early postoperative complications included 3 cases with pulmonary infection,2 cases with acute renal failure,1 case withsecond degree atrioventricular block;all of them were cured after treatment.The valve annulus structure was intact and with hemodynamic stabilization and no deaths occurred in all patients;the results were successful.Patients were followed up for 0.5-3.5 years.There were no cardiac rupture and perforation,tissue hemolysis,perivalvular leakage,thrombosis,endocardial infection recurrence and other complications.Conclusion Reconstruction of the annulus with autologous pericardium during the valve replacement is safe,reliable,convenient and economical,with fewer complications.

关 键 词：瓣环重建 自体心包片 重症瓣膜病 瓣膜外科 

分 类 号：R654.2[医药卫生—外科学]