再次三尖瓣手术治疗左心瓣膜术后孤立性三尖瓣反流的疗效分析  

Analysis of the clinical efficacy of redo tricuspid valve surgery in patients with isolated tricuspid regurgitation after left-sided valve surgery

作　　者：刘言一 葛圣林[1] 何维来[1] 李鑫[1] 刘善东[1] Liu Yanyi;Ge Shenglin;He Weilai;Li Xin;Liu Shandong(Department of Cardiac Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院心脏大血管外科,合肥230022

出　　处：《中华解剖与临床杂志》2022年第7期486-490,共5页Chinese Journal of Anatomy and Clinics

基　　金：安徽省自然科学基金(1808085MH279)。

摘　　要：目的探讨再次三尖瓣手术治疗左心瓣膜术后孤立性三尖瓣反流的临床疗效。方法回顾性研究。纳入2005年9月—2021年9月在安徽医科大学第一附属医院心脏大血管外科接受再次三尖瓣手术治疗的32例左心瓣膜术后孤立性三尖瓣反流患者的临床资料。其中男3例,女29例;年龄32~74(53.8±9.2)岁;三尖瓣置换术30例,三尖瓣成形术2例;16例于胸腔镜辅助下完成手术,16例经传统胸骨正中切口完成手术。观察患者体外循环时间、重症监护病房(ICU)时间、术后机械通气时间、术后住院时间、围术期死亡率及并发症发生率。根据随访结果,采用Kaplan-Meier法绘制生存曲线并计算术后生存率。结果32例患者手术均顺利完成。体外循环时间121.0(80.5,187.3)min,ICU停留时间4.0(2.0,10.5)d,术后机械通气时间41.0(16.3,87.3)h,术后住院20.0(12.0,29.0)d。围术期死亡8例(25.0%,8/32),24例(75.0%,24/32)治愈出院。围术期主要并发症:32例患者中,低心排综合征6例(18.8%)、呼吸衰竭10例(31.3%)、再次气管插管8例(25.0%)、气管切开5例(15.6%)、肺部感染8例(25.0%)、胸腔积液5例(15.6%)、急性肾衰竭6例(18.8%)、急性肝衰竭1例(3.1%)、消化道出血2例(6.3%)、切口愈合不良3例(9.4%)。随访22例(91.7%,22/24),随访时间26.5(17.3,42.0)个月,随访期间死亡4例,18例存活患者中纽约心脏协会心功能分级均恢复至Ⅰ~Ⅱ级。患者术后1、2、5年累积生存率分别为71.9%、68.5%、63.2%。结论再次三尖瓣手术治疗左心瓣膜术后孤立性三尖瓣反流安全有效,围术期及术后近、中期临床效果满意。Objective This study was performed to explore the clinical effect of redo tricuspid surgery for tricuspid regurgitation after left-sided valve surgery.Methods This work was a retrospective cohort study.A total of 32 patients with isolated tricuspid regurgitation after left-sided valve surgery received redo tricuspid surgeries from September 2005 to September 2021 in the Department of Cardiac Surgery of the First Affiliated Hospital of Anhui Medical University.The cohort included 30 cases of tricuspid valve replacement and 2 cases of tricuspid valve repair.The participants included 3 males and 29 females,aged 32-74(53.8±9.2)years.Thoracoscopic surgery was performed in 16 cases,and conventional median sternotomy surgery was performed in the other 16 cases.Cardiopulmonary bypass(CPB)time,intensive care unit(ICU)duration,postoperative ventilation time,length of postoperative hospital stay,perioperative mortality,and incidence of various complications were observed and analyzed.Survival curve and cumulative survival rate was calculated by Kaplan‐Meier method.Results For the 32 cases,CPB time was 121.0(80.5,187.3)min,ICU duration was 4.0(2.0,10.5)days,ventilation time was 41.0(16.3,87.3)h,and postoperative hospital stay was 20.0(12.0,29.0)days.Perioperative complications:Among the 32 patients,there were 6 cases of low cardiac discharge syndrome(18.8%),10 cases of respiratory failure(31.3%),8 cases of re-tracheal intubation(25.0%),5 cases of tracheotomy(15.6%),8 cases of pulmonary infection(25.0%),5 cases of pleural effusion(15.6%),6 cases of acute renal failure(18.8%)and 1 case of acute liver failure(3.1%),gastrointestinal bleeding in 2 cases(6.3%),poor wound healing in 3 cases(9.4%).Perioperative mortality was 25.0%(8/32),and 75.0%(24/32)of the cases were cured.A total of 22 cases(91.7%,22/24)were followed up,with follow-up time of 26.5(17.3,42.0)months.Four cases of deaths were recorded during follow-up period.The 18 cases who survived were categorized as classⅠ-Ⅱunder the New York Heart Association classifica

关 键 词：三尖瓣闭锁不全 三尖瓣反流 正中切口 胸腔镜 再次手术 瓣膜置换 瓣膜成形 

分 类 号：R654.2[医药卫生—外科学]