单手术组1年152例二尖瓣成形手术临床分析  

Clinical analysis of 152 mitral valvuloplasty surgeries performed by a single surgical team in one year

作　　者：何潇一 张林[1] 李东[1] 李梁刚 任瞳 王瑶[1] 姜胜利[1] He Xiaoyi;Zhang Lin;Li Dong;Li Lianggang;Ren Tong;Wang Yao;Jiang Shengli(Department of Cardiovascular Surgery,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心脏大血管外科,北京100853

出　　处：《中华胸心血管外科杂志》2022年第8期454-459,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的:总结单手术组1年完成二尖瓣手术的临床资料,探讨二尖瓣成形术病因学特点、成形方法、成形效果、手术入路及术后早期结果,分析收治各类二尖瓣疾病流行病学变化趋势。方法:回顾性分析2021年1月至2021年12月在解放军总医院第一医学中心心脏大血管外科由同一术者在单手术组完成的二尖瓣手术共209例。二尖瓣手术占同期本组全部手术53.6%。男100例(47.8%),女109例(52.2%);年龄11~85岁,平均(53.5±15.2)岁,心功能(NYHA分级)Ⅱ级121例(57.9%),Ⅲ/Ⅳ级88例(42.1%)。其中二尖瓣成形术152例(72.7%),二尖瓣置换术57例(27.3%)。结果:152例二尖瓣成形术中采用全胸腔入路117例(77%)。术中应用成形环145例(95.4%),其中PhysioⅡ成形环118例(81.4%),应用Gore-Tex人工腱索89例(58.6%)共145条,瓣叶成形15例(9.9%),缘对缘技术2例(1.3%),交界成形34例(22.4%),腱索及乳头肌劈开15例(9.9%)。退行性变成形率100%,风湿性心脏病成形率48.1%。术后1周左右复查超声心动图,二尖瓣无或微量反流91例(59.9%),轻度反流58例(38.2%),中度反流3例(2.0%)。术后全因死亡2例(1.3%),无成形效果不良再次手术患者。结论:本中心退行性二尖瓣病变已成为收治二尖瓣疾病首位,风湿性二尖瓣病变比例下降,退行性二尖瓣病变具有极高的成形率,风湿性二尖瓣病变由于其特殊的病理解剖特点,成形率相对较低。大部分二尖瓣成形术可经全胸腔镜方式完成。由经验丰富的术者应用二尖瓣成形环结合Gore-Tex人工腱索能够取得满意的成形效果。Objective To summarize the clinical data of mitral valve surgery completed in a single surgical team in one year,to discuss the etiologic characteristics,methods,results and early postoperative outcomes of mitral valvuloplasty surgeries,and to analyze the epidemiologic trends of mitral valve diseases admitted to the hospital.Methods A total of 209 mitral valve surgeries completed by the same surgeon in the single surgical team at the Cardiovascular Surgery,First Medical Center,Chinese PLA General Hospital,from January 2021 to December 2021 were retrospectively analyzed.Mitral valve surgery accounted for 53.6%of all surgeries in this team during the same period.There were 100 cases(47.8%)in males and 109 cases(52.2%)in females,aged 11-85 years old,with a mean of(53.5±15.2)years old.There were 121 cases(57.9%)of NYHA classⅡand 88 cases(42.1%)of classⅢ/Ⅳ.Results Of the 152 mitral valvuloplasty surgeries,117(77%)were performed with a totally Thoracoscopic approach.Annuloplasty rings were applied in 145 cases(95.4%),including semi-rigid closed Physio II annuloplasty rings in 118 cases(81.4%),Gore-Tex artificial chordae were applied in 89 cases(58.6%)for a total of 145,leaflet repair in 15 cases(9.9%),edge-to-edge repair in 2 cases(1.3%),commissure suture in 34 cases(22.4%),and chordae tendineae and papillary muscle splitting in 15 cases(9.9%).The repair rate of degenerative mitral valve disease was 100%,and the repair rate of rheumatic mitral valve disease was 48.1%.The echocardiogram was received about one week after surgery,and there was no or trace regurgitation in 91 cases(59.9%),mild in 58 cases(38.2%),and moderate in 3 cases(2.0%).There were 2 cases(1.3%)of all-cause death.Conclusion Degenerative mitral valve disease have become the leading cause of mitral valve disease in our center,and the proportion of rheumatic mitral valve disease has decreased.Degenerative mitral valve disease has a very high repair rate,and rheumatic mitral valve disease has a relatively low repair rate due to its special pathologi

关 键 词：二尖瓣成形术 二尖瓣成形环 成形率 人工腱索 全胸腔镜 

分 类 号：R654.2[医药卫生—外科学]