中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
29期
12-14
,共3页
高成山%金辉%孙广龙%毛国璋%吴留广%何磊%朱草原
高成山%金輝%孫廣龍%毛國璋%吳留廣%何磊%硃草原
고성산%금휘%손엄룡%모국장%오류엄%하뢰%주초원
二尖瓣脱垂%“缘对缘”技术%腱索转移
二尖瓣脫垂%“緣對緣”技術%腱索轉移
이첨판탈수%“연대연”기술%건색전이
Mitral valve prolapse%Technique of "edge-to-edge"%Chordal transfer
目的 介绍一种操作简单、效果可靠的矫治二尖瓣前叶脱垂的手术方法.方法 2004年1月至2010年10月,应用“缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂病例共18例,先行脱垂部位前叶与相应部位后叶的“缘对缘”缝合,矩形切下缝合处的后叶,连同相应的腱索、乳头肌,转移至前叶.再行后叶成形,完成瓣膜成形手术.所有患者出院前和半年后随访时再次行超声心动图检查.结果 手术无死亡病例,1例因术后第3天出现二尖瓣前叶穿孔再次行二尖瓣置换手术,血红蛋白尿1例,低心排血量综合征1例,给予对症处理,其余15例患者均顺利康复出院.术后远期随访无死亡,心功能全部恢复至Ⅰ级.复查超声心动图二尖瓣瓣口面积2.8~4.8(3.78±0.52) cm2,均无明显反流,反流面积(0.45±0.22) cm,左房径术前(48.26±11.12) mm,术后(37.57±9.56) mm(P= 0.028);左室舒张末径术前(61.43±8.24) mm,术后(42.35±10.79) mm(P=0.008).结论 “缘对缘”技术基础上的腱索转移法治疗二尖瓣前叶脱垂,操作简单,可以取得良好的成形效果.
目的 介紹一種操作簡單、效果可靠的矯治二尖瓣前葉脫垂的手術方法.方法 2004年1月至2010年10月,應用“緣對緣”技術基礎上的腱索轉移法治療二尖瓣前葉脫垂病例共18例,先行脫垂部位前葉與相應部位後葉的“緣對緣”縫閤,矩形切下縫閤處的後葉,連同相應的腱索、乳頭肌,轉移至前葉.再行後葉成形,完成瓣膜成形手術.所有患者齣院前和半年後隨訪時再次行超聲心動圖檢查.結果 手術無死亡病例,1例因術後第3天齣現二尖瓣前葉穿孔再次行二尖瓣置換手術,血紅蛋白尿1例,低心排血量綜閤徵1例,給予對癥處理,其餘15例患者均順利康複齣院.術後遠期隨訪無死亡,心功能全部恢複至Ⅰ級.複查超聲心動圖二尖瓣瓣口麵積2.8~4.8(3.78±0.52) cm2,均無明顯反流,反流麵積(0.45±0.22) cm,左房徑術前(48.26±11.12) mm,術後(37.57±9.56) mm(P= 0.028);左室舒張末徑術前(61.43±8.24) mm,術後(42.35±10.79) mm(P=0.008).結論 “緣對緣”技術基礎上的腱索轉移法治療二尖瓣前葉脫垂,操作簡單,可以取得良好的成形效果.
목적 개소일충조작간단、효과가고적교치이첨판전협탈수적수술방법.방법 2004년1월지2010년10월,응용“연대연”기술기출상적건색전이법치료이첨판전협탈수병례공18례,선행탈수부위전협여상응부위후협적“연대연”봉합,구형절하봉합처적후협,련동상응적건색、유두기,전이지전협.재행후협성형,완성판막성형수술.소유환자출원전화반년후수방시재차행초성심동도검사.결과 수술무사망병례,1례인술후제3천출현이첨판전협천공재차행이첨판치환수술,혈홍단백뇨1례,저심배혈량종합정1례,급여대증처리,기여15례환자균순리강복출원.술후원기수방무사망,심공능전부회복지Ⅰ급.복사초성심동도이첨판판구면적2.8~4.8(3.78±0.52) cm2,균무명현반류,반류면적(0.45±0.22) cm,좌방경술전(48.26±11.12) mm,술후(37.57±9.56) mm(P= 0.028);좌실서장말경술전(61.43±8.24) mm,술후(42.35±10.79) mm(P=0.008).결론 “연대연”기술기출상적건색전이법치료이첨판전협탈수,조작간단,가이취득량호적성형효과.
Objective To introduce a kind of operative technique in repair for the prolapse of the anterior mitral valve leaflet.Methods From January 2004 to October 2010,the operation of chordal transfer based on the"edge-to-edge" technique was performed in 18 cases with serious mitral valve regurgitation because of prolapse of the anterior leaflet.First,the "edge-to-edge" suturing was performed at the free edge of the prolapsed anterior leaflet with corresponding posterior leaflet.After that,quadrangular resection was performed to transfer these segments of posterior leaflet with its attached chordae.At last,the posterior leaflet was repaired after a quadrangular resection which would be much easier for the surgeons.After the operation,echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived after the operation,1 case required the rnitral valve replacement because of anterior leaflet performation occurring 3 days after the operation,1 case with hemoglobinuria and 1 case with low cardiac output,who all got symptomatic treatment afterwards.All the other patients were well discharged.At the time of follow-up,all of the patients were in NYHA functional class I.In all these patients,pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve:the cross-sectional area of the mitral valve was 2.8-4.8 (3.78 +0.52) cm2,the mean regurgitation area was (0.45 +0.22) cm2.At the same time,both dimension of left atrium and left ventricular reduced significantly [ left atrium diameter:pre-operation ( 48.26 + 11.12 ) mm,post-operation ( 37.57 ± 9.56) mm (P = 0.028 );the end-diastolic diameter of the left ventricular:pre-operation(61.43 ± 8.24) mm,post-operation (42.35 ±10.79) mm (P=0.008)].Conclusion Chordal transfer based on the "edge-to-edge" technique provides good results for repair of anterior leaflet prolapse.