不同病理类型的风湿性二尖瓣病变行瓣膜修复手术体会  

Experience of valve repair for different types of rheumatic mitral valve disease

作　　者：曹勇[1] 陈波[1] 余观水[1] 朱任 胡楝[1] 白培儒[1] Cao Yong;Chen Bo;Yu Guanshui;Zhu Ren;Hu Lian;Bai Peiru(Department of Cardiovascular Surgery,Gaozhou People's Hospital,Gaozhou 525200,China)

机构地区：[1]高州市人民医院心血管外科,525200

出　　处：《中华胸心血管外科杂志》2020年第10期589-592,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的收集风湿性二尖瓣病变行二尖瓣修复手术的早期疗效分析及随访结果,总结报道临床经验。方法回顾性分析2018年1月至2019年11月在高州市人民医院心血管外科48例风湿性二尖瓣病变患者进行二尖瓣修复术的临床资料。风湿性二尖瓣修复手术根据二尖瓣病变情况联合采用交界切开、瓣叶削薄、钙化剥除、腱索松解及乳头肌劈开方法,全部应用二尖瓣人工瓣环。合并三尖瓣关闭不全采用人工瓣环(C型环)固定,合并房颤患者均采用迷宫射频消融(Maze-Ⅳ)术式进行射频消融。收集体外循环时间、主动脉阻断时间、机械通气时间、ICU停留时间及术后主要并发症等资料。对患者进行随访,评估二尖瓣、心功能及心律等情况。结果根据病理分型,术中探查可见,Ⅰ型9例,Ⅱ型31例,Ⅲ型8例。其中Ⅰ、Ⅱ型病例均修复成功,Ⅲ型中出现1例患者因术中心脏复搏后出现二尖瓣中度反流而中转行二尖瓣生物瓣置换术。体外循环时间(110.62±27.68)min、主动脉阻断时间(76.63±17.63)min,ICU停留(46.16±11.37)h,机械通气(21.60±10.89)h。全组术后30天无死亡,术后出现急性肾衰竭1例,低心排血量综合征1例,肺部感染3例,无卒中、恶性心律失常等并发症。对完成瓣膜修复的47例患者进行随访,随访(9.86±6.78)月,随访率100%,随访期间无死亡、恶性心律失常、再次手术等事件发生,随访心脏功能获得明显改善(P<0.001)。结论风湿性二尖瓣病变的修复,保留了完整的二尖瓣结构,有利于维持心脏功能,具有良好的生存率及生活质量。在熟练掌握心脏瓣膜修复的基础上,熟悉风湿性二尖瓣病变的解剖特征,严格把握适应证,术前充分评估,开展风湿性二尖瓣修复手术是可行的,针对不同的病理类型而采取相应策略,术后早期临床效果满意,远期效果建议长期随访观察。Objective To summarize the early results and follow-up of mitral valve repair for rheumatic heart disease(RHD).Methods From January 2018 to November 2019,48 patients with rheumatic heart disease undergoing mitral valve repair in Cardiovascular Surgery Department of GaoZhou People's Hospital were analyzed retrospectively.Surgical methods:according to the condition of mitral valve disease,the prosthetic mitral annulus was used in rheumatic mitral valve repair by the methods of joint incision,valve thinning,calcification stripping,Chordae tendineae release and papillary muscle splitting.All patients with tricuspid regurgitation were fixed with artificial valve ring(type C ring),and with atrial fibrillation were treated with Maze-IV radiofrequency ablation.Data on extracorporeal circulation time,aortic occlusion time,mechanical ventilation time,ICU stay time,and major postoperative complications were collected.Patients were followed up to assess mitral valve,cardiac function,and cardiac rhythm.Results According to pathological classification,typeⅠwere 9 cases,31 cases as typeⅡand 8 cases as typeⅢ.All patients in type I and type II were repaired successfully,and type III has 1 case who was repaired failed and underwent mitral valve replacement due to moderate regurgitation.Cardiopulmonary bypass(CPB)time was(110.62±27.68)min,Cross-clamp time was(76.63±17.63)min,ICU stay was(46.16±11.37)h,mechanical ventilation was(21.60±10.89)h.All survived at 30 days,1 case of acute renal failure,1 case of low cardiac output syndrome,3 cases of pulmonary infection,no complications such as stroke and malignant Arrhythmia.47 patients were followed up for(9.86±6.78)months.There were no death,malignant Arrhythmia and reoperation during the follow-up,and the cardiac function was improved significantly(P<0.001).Conclusion The mitral valve repair of RHD can preserve the intact mitral valve structure,maintain the heart function,and have a good survival and quality of life.On the basis of mastering the repair of heart valve,being f

关 键 词：风湿性心脏病 二尖瓣修复 手术治疗 临床经验 

分 类 号：R654.2[医药卫生—外科学]