目的 评价实时三维经食管超声（RT3D-TEE）技术于二尖瓣成形术中判断瓣叶病变及病变区域等方面的准确性。方法 123例单纯二尖瓣反流并接受瓣膜成形手术的患者，术中在全身麻醉后插入食管探头先后行二维（2D-TEE）和RT3D-TEE检查，然后由2组经验丰富的超声医师分别将留存的超声图像作脱机分析并最终与手术所见进行比较。结果 RT3D-TEE对二尖瓣脱垂的诊断及其对病变区域判断的准确率显著高于2D-TEE（P=0.001）；虽然在对腱索断裂患者的诊断准确率方面与2D-TEE 的差异无统计学意义（P=0.291），但在判断腱索断裂起源区域的准确率仍显著高于2D-TEE（P<0.05）；RT3D-TEE诊断二尖瓣单纯瓣叶裂的敏感度达100%。结论 RT3D-TEE用于二尖瓣成形术中可以准确地评估二尖瓣脱垂及其区域、腱索断裂及其部位，尤其在判断复杂脱垂病变及多区域发生的腱索断裂等方面RT3D-TEE都较2D-TEE有独到的优势，也是超声诊断瓣叶裂最有效的方法。

Objective To assess systematically the accuracy of real-time three-dimensional transesophageal echocardiography (RT3D-TEE) in identifying involvement of mitral valve leaflets and scallops during mitral valvuloplasty. Methods One hundred and twenty-three patients with isolated mitral regurgitation for mitral valve repair were studied. Two-dimensional transesophageal echocardiography (2D-TEE) and RT3D-TEE were performed separately after general anesthesia. Two experienced interpreters analyzed the restored image offline and compared them with surgical findings. Results The diagnostic accuracy of RT3D-TEE in identifying mitral valve prolapse and its localization was significantly higher than that of 2D-TEE (P=0.001). There was no significant difference in diagnosing mitral valve chordal rupture between the two techniques (P=0.291), while the accuracy of RT3D-TEE in judging the region of chordal rupture was significantly higher (P<0.05). RT3D-TEE had a sensitivity of 100% in diagnosing simple leaflet cleft. Conclusion RT3D-TEE may accurately assess mitral valve prolapse, chordal rupture and its position, especially in diagnosing complex mitral valve prolapse and multiple chordal rupture. RT3D-TEE is thus a powerful tool in mitral valve repair, and is the most efficient modality in diagnosing mitral valve cleft.