二尖瓣成形与置换术治疗功能性二尖瓣反流中远期疗效比较:10年单中心结果  

Mid- and long-term efficacy of mitral valve plasty versus replacement in the treatmentof functional mitral regurgitation: A 10-year single-center outcome

作　　者：梁汉青 万巧丽 魏韬 李瑞 郭志鹏 张建 尹宗涛 韩劲松 LIANG Hanqing;WAN Qiaoli;WEI Tao;LI Rui;GUO Zhipeng;ZHANG Jian;YIN Zongtao;HAN Jinsong(General Hospital of Northern Theater Command,The Graduate Training Base of Jinzhou Medical University,Shenyang,110016,P.R.China;Department of Cardiovascular Surgery,Xuzhou First People's Hospital,Xuzhou,221000,Jiangsu,P.R.China;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang,110016,P.R.China)

机构地区：[1]锦州医科大学北部战区总医院研究生培养基地,沈阳110016 [2]徐州市第一人民医院心脏大血管外科,江苏徐州221000 [3]北部战区总医院心血管外科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2025年第1期108-113,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：2022年辽宁省应用基础研究(2022JH2/101300085)。

摘　　要：目的 比较二尖瓣成形与置换术治疗功能性二尖瓣反流(functional mitral regurgitation,FMR)的中远期临床疗效。方法 选取2012—2021年在北部战区总医院心血管外科行手术治疗的FMR患者为研究对象。根据手术方式将患者分为二尖瓣成形术组(MVP组)和二尖瓣置换术组(MVR组)。比较两组患者的临床资料和中远期随访疗效。结果 纳入236例患者。MVP组100例,其中男53例、女47例,平均年龄(61.80±8.03)岁。MVR组136例,其中男72例、女64例,平均年龄(61.29±8.97)岁。两组患者基线资料差异无统计学意义(P>0.05)。两组体外循环时间、主动脉阻断时间、术后住院时间、监护室停留时间、术中失血量和住院死亡率等差异均无统计学意义(P>0.05),但MVP组术后机械通气时间较MVR组明显缩短,差异有统计学意义(P=0.022)。总随访率100.0%,最长随访10年,平均随访时间(3.60±2.55)年。两组患者随访时左心房内径、左心室舒张末期内径、左心室收缩末期内径和心功能等级与术前差异均有统计学意义(P<0.05)。MVP组的左心室射血分数较术前显著提高(P=0.002),MVR组的左心室射血分数较术前差异无统计学意义(P=0.658)。术后MVP组的左心房内径较MVR组缩小,差异有统计学意义(P=0.026)。MVP组二尖瓣反流复发率高于MVR组,差异有统计学意义(10.0%vs. 1.5%,P=0.003)。MVP组累计死亡14例,MVR组累计死亡19例。Kaplan-Meier生存分析显示,两组患者累计生存率(P=0.605)与免于心脑血管事件的生存率(P=0.875)差异均无统计学意义。结论 二尖瓣成形术治疗FMR安全性及中远期临床疗效优于二尖瓣置换术,左心房、左心室内径显著减小,心功能明显改善。但是术者需要严格掌握二尖瓣成形术的适应证以降低二尖瓣反流复发率。Objective To compare the mid-and long-term clinical results of mitral valve plasty(MVP)and mitral valve replacement(MVR)in the treatment of functional mitral regurgitation(FMR).Methods Patients with FMR who underwent surgical treatment in the Department of Cardiovascular Surgery of the General Hospital of Northern Theater Command from 2012 to 2021 were collected.The patients who underwent MVP were divided into a MVP group,and those who underwent MVR into a MVR group.The clinical data and mid-term follow-up efficacy of two groups were compared.Results Finally 236 patients were included.There were 100 patients in the MVP group,including 53 males and 47 females, with an average age of (61.80±8.03) years. There were 136 patients in the MVR group, including 72 malesand 64 females, with an average age of (61.29±8.97) years. There was no statistical difference in baseline data between thetwo groups (P>0.05). There was no statistical difference between the two groups in the extracorporeal circulation time,aortic occlusion time, postoperative hospital and ICU stay, intraoperative blood loss, or hospitalization death (P>0.05), butthe time of mechanical ventilation in the MVP group was significantly shorter than that in the MVR group (P=0.022). Thetotal follow-up rate was 100.0%, the longest follow-up was 10 years, and the average follow-up time was (3.60±2.55) years.There were statistical differences in the left atrial diameter, left ventricular end-diastolic diameter, left ventricular endsystolicdiameter and cardiac function between the two groups compared with those before surgery (P<0.05). Thepostoperative left ventricular ejection fraction in the MVP group was statistically higher than that before surgery(P=0.002), but there was no statistical difference in the MVR group before and after surgery (P=0.658). The left atrialdiameter in the MVP group was reduced compared with the MVR group (P=0.026). The recurrence rate of mitralregurgitation in the MVP group was higher than that in the MVR group, and the difference was

关 键 词：二尖瓣反流 功能性二尖瓣反流 二尖瓣成形术 二尖瓣置换术 

分 类 号：R654.2[医药卫生—外科学]