中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2008年
22期
1727-1729
,共3页
甘辉立%张健群%王胜洵%周其文%孔晴宇%郑斯宏%伯平%黄国辉%陈伟
甘輝立%張健群%王勝洵%週其文%孔晴宇%鄭斯宏%伯平%黃國輝%陳偉
감휘립%장건군%왕성순%주기문%공청우%정사굉%백평%황국휘%진위
二尖瓣脱垂%心脏外科手术%治疗结果
二尖瓣脫垂%心髒外科手術%治療結果
이첨판탈수%심장외과수술%치료결과
Mitral valve prolapse%Cardiac surgical procedures%Treatment outcome
目的 评价腱索折叠和人工腱索两种成形术治疗二尖瓣前瓣脱垂(ALP)的效果.方法 回顾性分析1990年3月至2008年3月接受上述两种成形术治疗的50例ALP患者的临床资料.全组男性29例,女性21例;年龄(42.6±11.3)岁.其中腱索折叠组23例,人工腱索组27例.结果 围手术期腱索折叠组病死率13.0%(3/23),高于人工腱索组的3.7%(1/27)(P=0.199).随访时间为1个月～18年,总随访时间为278人年.两组晚期死亡各3例,5～8年生存率腱索折叠组为70.0%±18.2%,人工腱索组为86.8%±9.2%(χ2=8.17,P=0.046).再次手术腱索折叠组4例,人工腱索组1例,两次手术间隔时间为(26±17)个月;5年免除再次手术率分别为83.3%±15.2%和100%(χ2=12.06,P=0.007).多因素回归分析显示,腱索折叠术是ALP成形术晚期心脏事件的独立危险因素.结论 人工腱索成形术矫治ALP在远期生存上要优于腱索折叠术.
目的 評價腱索摺疊和人工腱索兩種成形術治療二尖瓣前瓣脫垂(ALP)的效果.方法 迴顧性分析1990年3月至2008年3月接受上述兩種成形術治療的50例ALP患者的臨床資料.全組男性29例,女性21例;年齡(42.6±11.3)歲.其中腱索摺疊組23例,人工腱索組27例.結果 圍手術期腱索摺疊組病死率13.0%(3/23),高于人工腱索組的3.7%(1/27)(P=0.199).隨訪時間為1箇月～18年,總隨訪時間為278人年.兩組晚期死亡各3例,5～8年生存率腱索摺疊組為70.0%±18.2%,人工腱索組為86.8%±9.2%(χ2=8.17,P=0.046).再次手術腱索摺疊組4例,人工腱索組1例,兩次手術間隔時間為(26±17)箇月;5年免除再次手術率分彆為83.3%±15.2%和100%(χ2=12.06,P=0.007).多因素迴歸分析顯示,腱索摺疊術是ALP成形術晚期心髒事件的獨立危險因素.結論 人工腱索成形術矯治ALP在遠期生存上要優于腱索摺疊術.
목적 평개건색절첩화인공건색량충성형술치료이첨판전판탈수(ALP)적효과.방법 회고성분석1990년3월지2008년3월접수상술량충성형술치료적50례ALP환자적림상자료.전조남성29례,녀성21례;년령(42.6±11.3)세.기중건색절첩조23례,인공건색조27례.결과 위수술기건색절첩조병사솔13.0%(3/23),고우인공건색조적3.7%(1/27)(P=0.199).수방시간위1개월～18년,총수방시간위278인년.량조만기사망각3례,5～8년생존솔건색절첩조위70.0%±18.2%,인공건색조위86.8%±9.2%(χ2=8.17,P=0.046).재차수술건색절첩조4례,인공건색조1례,량차수술간격시간위(26±17)개월;5년면제재차수술솔분별위83.3%±15.2%화100%(χ2=12.06,P=0.007).다인소회귀분석현시,건색절첩술시ALP성형술만기심장사건적독립위험인소.결론 인공건색성형술교치ALP재원기생존상요우우건색절첩술.
Objective To compare the relative merits between chordal shortening and artificial chordae to repair the anterior leallet prolapses (ALP). Methods The clinic data of 50 cases underwent repair of ALP from March 1990 to March 2008 were analyzed retrospectivdy. There were 29 male and 21 female patients with a mean age of (42.6±11.3) years old. There were 23 patients in chordal shortening group and 27 patients in artificial chordae group. Results There were 3 operative deaths in chordal shortening group (13.0%), and 1 death in artificial ehordae group (3.7%, P=0.199). With a mean follow-up of (5.8±4.8) years and a total follow-up of 278 patient-years, there were 3 late deaths respectively in each group. According the Kaplan-Meier survival curve, the actuarial survival rate at 5～8 years was 70.0%±18.2% for chordal shortening group and 86.8%±9.2% for artificial chnrdae group (χ2=8.17, P=0.046). There were 5 reoperations, of which 4 in chordal shortening group and 1 in artificial chordae group. According to the Kaplan-Meier freedom from reoperation curve, the freedom from reoperation at 5 years was 83.3%±15. 2% for chordal shortening group and 100% for artificial chordae group (χ2=12.06, P=0.007). The COX proportional hazard regressions revealed that chordal-shortening technique was the independent risk predictor for the late cardiac event after ALP surgical repairment. Conclusion Artificial chnrdae techniques has a relative superiority to chordal shortening for repair of mitral valve ALP.
