上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (3): 327-.doi: 10.3969/j.issn.1674-8115.2013.03.015

• 论著（临床研究） • 上一篇    下一篇

应用三种二尖瓣前叶成形技术治疗二尖瓣关闭不全的对照研究

张 卫, 方 亮, 叶 伟   

  1. 上海交通大学附属胸科医院心血管外科, 上海 200030
  • 出版日期:2013-03-28 发布日期:2013-03-29
  • 作者简介:张 卫（1960—）, 男, 主任医师, 硕士生导师； 电子信箱: zhangwyyy@citiz.net。

Comparison of three techniques of anterior mitral valve repair in treatment of mitral insufficiency

ZHANG Wei, FANG Liang, YE Wei   

  1. Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2013-03-28 Published:2013-03-29

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摘要：

目的 比较腱索转移、缘对缘缝合和人工腱索置入三种方法治疗二尖瓣前叶病变引起的二尖瓣关闭不全的效果。方法 将因二尖瓣前叶病变接受手术治疗的171例患者按手术方式不同分为腱索转移组（Ⅰ组）、缘对缘技术组（Ⅱ组）和人工腱索置入组（Ⅲ组），每组各57例。经食道超声心动图(TEE)检测二尖瓣关闭情况；心脏彩色超声测量有效瓣口面积和左心功能相关指标；随访近中期二尖瓣关闭情况。结果 术后TEE检测结果显示,Ⅰ、Ⅱ、Ⅲ组二尖瓣关闭良好的患者分别占82.46%（47/57）、85.96%（49/57）和84.21%（48/57）。三组术后有效瓣口面积均明显小于术前（P<0.05）；术后左心室舒张末内径均较术前明显缩短（P<0.05）。随访1～11年（平均3.28年），Ⅰ、Ⅱ、Ⅲ组二尖瓣关闭良好的患者分别占82.46%（47/57）、85.96%（49/57）和82.46%（47/57）。结论 腱索转移、人工腱索置入和缘对缘技术均是治疗二尖瓣前叶病变的有效方法，应根据患者年龄和具体病变情况选择手术方式。

关键词: 二尖瓣前叶病变, 二尖瓣关闭不全, 手术

Abstract:

Objective To compare the effects of chordal transfer, edge-to-edge suture and artificial chordae techniques in treatment of mitral insufficiency induced by anterior mitral valve diseases. Methods According to different surgical methods, 171 patients with anterior mitral valve diseases were divided into chordal transfer group (group Ⅰ), edge-to-edge suture group (group Ⅱ) and artificial chordate group (group Ⅲ), with 57 patients in each group. The mitral valve close was examined by transesophageal echocardiography (TEE), the effective mitral valve areas and parameters related to left ventricular function were measured by transthoracic echo, and the short and middle term data of mitral valve close were followed up. Results The percentages of patients with satisfied mitral valve revealed by postoperative TEE in group Ⅰ, group Ⅱ and group Ⅲ were 82.46% (47/57), 85.96% (49/57) and 84.21% (48/57), respectively. The postoperative effective mitral valve areas of all three groups were significantly smaller than those before operation (P<0.05). The postoperative left ventricular end diastolic diameters in all three groups were significantly shorter than those before operation (P<0.05). After follow up for 1 to 11 years (3.28 years in average), the percentages of satisfied mitral valve close in group Ⅰ, group Ⅱ and group Ⅲ were 82.46% (47/57), 85.96% (49/57) and 82.46% (47/57), respectively. Conclusion Chordal transfer, edge-to-edge suture and artificial chordae techniques are effective in treatment of anterior mitral valve diseases, and the choice of surgical procedure should be based on the age and disease condition.

Key words: anterior mitral valve diseases, mitral insufficiency, surgery