CAJ | 학술논문

目的观察总结置入人工成形环的三尖瓣成形方法的临床中、远期效果.方法 2001年9月至2008年9月我院收治合并左心系统瓣膜病变的功能性三尖瓣关闭不全(TR)277例,行左心瓣膜手术时同期行三尖瓣成形术:其中采用单纯缝线瓣环(不上环)成形、不置入成形环的共203例,置入人工成形环的共74例;同期所行左心瓣膜手术包括二尖瓣置换(MVR)146例、二尖瓣成形(MVP)31例、MVR+主动脉瓣置换(AVR)81例,冠状动脉旁路移植(CABG)+MVR 8例、CABG+MVP 11例.观察比较术后1.5年及3.5年2组患者的临床及心脏超声随访资料.结果所有病例都完成1.5年随访;共有245例(89.9%)完成长期随访(3.5年或以上).术后1.5年随访发现中度以下再发性TR 2组差异无统计学意义(χ2=1.3128,P=0.26),中重度者上环组明显低于非上环组(χ2=5.8159,P=0.023).远期随访发现上环组无TR比率明显高于非上环组[上环组25%(16/64),非上环组15%(27/181,χ2=4.9328,P=0.036],发展为中度以上TR的比率非上环组显著地高于上环组[非上环组34%(62/181),上环组10%(6/64),χ2=7.9120,P=0.005].组内两个时间段相比,非上环组TR进展明显增快[随访1.5年18%(36/197),3.5年34%(62/181),χ2=2.1327,P=0.016],而上环组相对稳定[随访1.5年7%(5/64),3.5年10%(6/60),χ2=0.3964,P=0.62].结论置入成形环的三尖瓣成形术的临床中、远期效果明显好于单纯缝线成形术.对于功能性TR的处理应持更加积极的态度,而且应尽量采用人工瓣环置入的方法进行三尖瓣缩环成形.
목적 관찰총결치입인공성형배적삼첨판성형방법적림상중、원기효과.방법 2001년9월지2008년9월아원수치합병좌심계통판막병변적공능성삼첨판관폐불전(TR)277례,행좌심판막수술시동기행삼첨판성형술:기중채용단순봉선판배(불상배)성형、불치입성형배적공203례,치입인공성형배적공74례;동기소행좌심판막수술포괄이첨판치환(MVR)146례、이첨판성형(MVP)31례、MVR+주동맥판치환(AVR)81례,관상동맥방로이식(CABG)+MVR 8례、CABG+MVP 11례.관찰비교술후1.5년급3.5년2조환자적림상급심장초성수방자료.결과 소유병례도완성1.5년수방;공유245례(89.9%)완성장기수방(3.5년혹이상).술후1.5년수방발현중도이하재발성TR 2조차이무통계학의의(χ2=1.3128,P=0.26),중중도자상배조명현저우비상배조(χ2=5.8159,P=0.023).원기수방발현상배조무TR비솔명현고우비상배조[상배조25%(16/64),비상배조15%(27/181,χ2=4.9328,P=0.036],발전위중도이상TR적비솔비상배조현저지고우상배조[비상배조34%(62/181),상배조10%(6/64),χ2=7.9120,P=0.005].조내량개시간단상비,비상배조TR진전명현증쾌[수방1.5년18%(36/197),3.5년34%(62/181),χ2=2.1327,P=0.016],이상배조상대은정[수방1.5년7%(5/64),3.5년10%(6/60),χ2=0.3964,P=0.62].결론 치입성형배적삼첨판성형술적림상중、원기효과명현호우단순봉선성형술.대우공능성TR적처리응지경가적겁적태도,이차응진량채용인공판배치입적방법진행삼첨판축배성형.
Objective To compare the mid- and long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. Methods Two hundred seventy-seven patients underwent TV repair at our division (Sep. 2001 to Sep. 2008) ,of which 203 had, predominantly, a De Vega or Kay procedure (non-ring group) and 74had an annuloplasty with an artificial ring (ring group). TV pathology mainly was functional (secondary) and several with rheumatic leaflets involvement. Concomitant procedures consisted of mitral valve surgery in all patients,aortic valve surgery in 81 ,and coronary bypass in 19. Clinical and echocardiographic data followed for 1.5 to 3.5years were obtained. Results Postoperationally,the mid-term(1.5 years) follow-up was 100% completed and the long-term follow-up for 3. 5 years was 89. 9%. The recurrence of TV regurgitation (TR) of moderate and lower degree was not significantly different(χ2 = 1.3128, P= 0.26) in the 1.5 years follow-up between the two group,whereas the recurrence of TR of moderate to severity degree was significantly less in the ring group (χ2 =5. 8159,P =0.023).In the long term follow up,the TR in the ring group (25%) was significantly lower than that of 15% in the non-ring group (χ2 = 4. 9328, P = 0.036) . There are higher proportion of patients developing to moderate TR in the non ring group(34%) than in the ring group (10%) (χ2 =7. 9120,P =0.005). The TR developed fast in the ring group,increasing from 18% at 1.5 years follow up to 10% at 3.5 years follow up (χ2 = 2. 1327, P = 0.016),whereas it was relatively stable in the non-ring group,with 7% at 1.5 year follow up and 10% at 3.5 year follow up. Conclusions Placement of an annuloplasty ring in patients undergoing TV repair could remarkably improved the mid and long terum outcome. In clinic practice, we should be more positive to the functional TR and prefer to the procedure with annuloplasty ring.