二尖瓣狭窄分离术后晚期复发病人瓣膜置换术278例分析  

Prosthetic valve replacement for late recurrent valvular heart disease after closed mitral commissurotomy in 278 cases

作　　者：张宝仁[1] 徐志云[1] 邹良建[1] 梅举[1] 王志农[1] 蔡凯华[1] 

机构地区：[1]中国人民解放军胸心外科研究所第二军医大学长海医院胸心外科,上海200433

出　　处：《中华胸心血管外科杂志》2003年第4期200-203,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨风湿性二尖瓣狭窄闭式扩张分离术后晚期复发瓣膜的病理改变 ,及其再次手术方式的选择。方法　 1978年 12月至 2 0 0 1年 12月共收治风湿性二尖瓣狭窄闭式扩张分离术后晚期复发性瓣膜病 2 78例。二尖瓣复发性病变均以狭窄为主合并不同程度的关闭不全。其中合并三尖瓣功能性关闭不全 12 7例 (4 5 7% ) ,合并复发性主动脉瓣病变 33例 (11 9% ) ;二尖瓣与主动脉瓣双瓣膜病变合并三尖瓣病变 6 1例 (2 1 9% )。二尖瓣复发性病变的病理特点主要表现为 (1)交界硬化融合型 4 6例 (16 5 % ) ;(2 )后瓣钙化卷缩型 18例 (6 5 % ) ;(3)交界钙化融合型 177例 (6 3 7% ) ;(4 )瓣膜与瓣下结构钙化型 37例(13 3% )。所有病人均行二尖瓣置换术 ,其中二尖瓣与主动脉瓣双瓣置换术 33例 ;三尖瓣功能性关闭不全作改良DeVega成形术 137例、Kay二瓣化环缩术加用成形环固定 5 1例。 结果　早期死亡 19例(6 8% ) ,主要死因为心力衰竭与多脏器功能衰竭。长期生存 2 5 9例 ,随访率 95 7% ,随访 6个月～ 2 2年 ,累计随访时间 116 2 2年。晚期死亡 15例 ,累计生存率 5、10、15年分别为 85 5 %、71 2 %、6 5 1%。抗凝过量出血的发生率为 1 11%病人·年。结论　风湿性二尖瓣狭窄闭式扩张术后晚期瓣膜复发性病变 ,再次?Objective: To analyze the pathological changes of mitral valve in patients with late recurrent valvular heart disease after mitral commissurotomy and re operative methods in concern with surgical intervention. Methods: 278 patients with late recurrent valvular heart disease after mitral commissurotomy for rheumatic mitral stenosis were treated surgically between December, 1978 through December, 2001. All patients had predominantly recurrent mitral stenosis with variable degrees of mitral regurgitation. Concomitant recurrent aortic valvular lesions were found in 33 cases (11.9%) and functional tricuspid regurgitation in 127 (45.7%) as well as combined mitral and aortic valvular diseases associated with tricuspid valve disease in 61 (21.9%). The pathological lesions of the mitral valve showed four different patterns: commissural stiffness and fusion type (46 patients, 16.5%), rolled posterior leaflet type (18 patients, 6.5%), commissural fusion and calcification type (177 patients, 63.7%), and combined valvular and subvalvular calcification type (37 patients, 13.3%). All patients received re operation with the prosthetic mitral valve replacement, including 33 of concomitant mitral and aortic valve replacements. The associated functiona1 tricuspid lesions were treated at the same time including 137 patients receiving modified De Vega's valvuloplasty and 51 Kay's bicuspidate valvuloplasty reinforced with an artificial valvular ring. Results: 19 patients died during the hospital stay with an early operative mortality of 6.8%. The major cause of early death was heart failure or multiple organ function failure. 259 patients were survived and 95.7% of them were carefully followed with duration of follow up varied from 6 months to 22 years (cumulative follow up time of 1?162.2 years). There were 15 late deaths. The actuarial survival rates at 5, l0 and l5 years were 85.5%, 71.2% and 65.1%, respectively. The incidence of anticoagulation related bleeding was 1.11% patient·year. Conclusion: The main pathological lesions

关 键 词：二尖瓣狭窄分离术 晚期复发病人 瓣膜置换术 心脏瓣膜疾病 

分 类 号：R654.2[医药卫生—外科学]