1275例二尖瓣反流患者行全胸腔镜微创二尖瓣成形术的长期随访结果分析  

Analysis on the long term results of total thoracoscopic minimally invasive mitral valvuloplasty in 1275 patients with mitral regurgitation

作　　者：钟丽珊 黄燕莹[1,2] 汪珍忠 肖硕 李玉欣 方斗 王秋吉 张朝龙 黄焕雷[1,4] ZHONG Lishan;HUANG Yanying;WANG Zhenzhong;XIAO Shuo;LI Yuxin;FANG Dou;WANG Qiuji;ZHANG Chaolong;HUANG Huanlei(Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital of Southern Medical University(Guangdong Academy of Medical Sciences),Guangzhou 510080,China;Guangdong Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;South China University of Technology School of Medicine,Guangzhou 510006,China;Department of Cardiac Surgery,Guangdong Provincial People's Hospital of Southern Medical University(Guangdong Academy of Medical Sciences),Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所,南方医科大学附属广东省人民医院(广东省医学科学院),广州510080 [2]广东省心血管病研究所,广东省人民医院,广东省医学科学院,广州510080 [3]华南理工大学医学院,广州510006 [4]南方医科大学附属广东省人民医院(广东省医学科学院)心外科,广州510080

出　　处：《中国临床新医学》2024年第3期244-251,共8页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：国家自然科学基金面上项目(编号:82270373);广东省省级科技计划项目(编号:2020B1111170011);广东省基础与应用基础研究基金重点项目(编号:2019B1515120071);广州市卫生健康委员会项目(编号:2023FTJCZ0011)。

摘　　要：目的明确全胸腔镜微创二尖瓣成形术(TCMI-MVP)在治疗二尖瓣反流(MR)的安全性、有效性和耐久性。方法回顾性分析2009年1月1日至2022年6月1日在广东省人民医院接受TCMI-MVP的1275例MR患者的中远期结果。根据随访结果将患者分为MR未复发组(A组,1098例)和MR复发组(B组,177例),比较两组术前、术中、术后资料以及随访情况。结果随访率为96.24%,中位随访时间为4.42(0.00,13.20)年。整个队列患者1年、3年、5年和10年的生存率分别为99.5%、98.5%、97.8%和95.5%。两组生存预后差异无统计学意义(χ^(2)=0.350,P=0.554)。当未考虑死亡为竞争风险时,整个队列患者1年、3年、5年和10年MR≥2+的复发豁免率分别为90.4%、87.4%、85.6%和78.3%。当考虑死亡为竞争风险时,术后进展为MR≥2+的累积发生率在1年、3年、5年和10年时,分别为9.6%、12.5%、14.3%和21.4%。通过多因素Cox回归分析发现,患有高血压[HR(95%CI)=1.70(1.18~2.44),P=0.004]、同时行三尖瓣成形手术[HR(95%CI)=1.65(1.16~2.36),P=0.006]、较大的术前左心室收缩末期内径[HR(95%CI)=1.09(1.03~1.15),P=0.002]、较大的术后1周左心房内径[HR(95%CI)=1.03(1.01~1.06),P=0.031]和术后1周MR分级程度高[HR(95%CI)=59.63(21.84~162.82),P<0.001]是MR复发的危险因素。总体患者1年、3年、5年和10年再次二尖瓣手术的豁免率分别为99.6%、98.9%、98.7%和97.9%。结论先进瓣膜中心合理地运用各项修复技术行TCMI-MVP是安全、有效的,可获得良好的远期修复效果。Objective To clarify the safety,efficacy and durability of total thoracoscopic minimally invasive mitral valvuloplasty(TCMI-MVP)in the treatment of mitral regurgitation(MR).Methods The medium and long term results of 1275 MR patients who received TCMI-MVP in Guangdong Provincial People's Hospital from January 1,2009 to June 1,2022 were retrospectively analyzed.The patients were divided into non-recurrent MR group(group A,1098 cases)and recurrent MR group(group B,177 cases)according to the follow-up results.The preoperative,intraoperative and postoperative data and the follow-up results were compared between the two groups.Results The follow-up rate was 96.24%,and the median follow-up time was 4.42(0.00,13.20)years.The 1-,3-,5-and 10-year survival rates of the patients in the entire cohort were 99.5%,98.5%,97.8% and 95.5%,respectively.There was no significant difference in survival prognosis between the two groups(χ^(2)=0.350,P=0.554).When death was not considered as a competing risk,the recurrent exemption rates of the patients for MR≥2+at 1 year,3 years,5 years and 10 years were 90.4%,87.4%,85.6% and 78.3% in the entire cohort,respectively.When death was considered as a competing risk,the cumulative incidence rates of postoperative progression with MR≥2+at 1 year,3 years,5 years and 10 years were 9.6%,12.5%,14.3%and 21.4%,respectively.Multivariate Cox regression analysis showed that suffering from high blood pressure[HR(95%CI)=1.70(1.18-2.44),P=0.004],receiving simultaneous tricuspid valvuloplasty[HR(95%CI)=1.65(1.16-2.36),P=0.006],larger preoperative left ventricular end-systolic diameter[HR(95%CI)=1.09(1.03-1.15),P=0.002],larger left atrial diameter 1 week after operation[HR(95%CI)=1.03(1.01-1.06),P=0.031]and high MR grading 1 week after operation[HR(95%CI)=59.63(21.84-162.82),P<0.001]were risk factors for MR recurrence.The overall exemption rates of the patients for mitral valve reoperation at 1 year,3 years,5 years,and 10 years were 99.6%,98.9%,98.7% and 97.9%,respectively.Conclusion TCMI-MVP is safe an

关 键 词：二尖瓣反流 全胸腔镜微创 二尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]