中国医疗前沿
中國醫療前沿
중국의료전연
CHINA HEALTHCARE INNOVATION
2013年
15期
3-5
,共3页
褚银平%高奇英%张羽%崔少鹏%张栋
褚銀平%高奇英%張羽%崔少鵬%張棟
저은평%고기영%장우%최소붕%장동
三尖瓣关闭不全%三尖瓣环成形术%人工瓣环成形术%De Vega成形术
三尖瓣關閉不全%三尖瓣環成形術%人工瓣環成形術%De Vega成形術
삼첨판관폐불전%삼첨판배성형술%인공판배성형술%De Vega성형술
Tricuspid regurgitation%Tricuspid valvuloplasty%Ring annuloplasty%De Vega's annuloplasty suture
目的评价功能性三尖瓣中、重度关闭不全患者行人工环成形术和De Vega成形术后的近期临床效果。方法2010年1月-2012年12月，我院行三尖瓣环成形术65例。根据手术方式分为2组：De Vega成形组(De Vega组)30例，人工环成形组(人工环组)35例。对所有患者在不同随访时间点采用超声心动图观察术后三尖瓣的反流情况，比较两组患者近期手术疗效。结果术后两组患者均无手术死亡；随访0.5-2.6年。术后心功能分级均较术前改善2-3级；术后6个月，右心房内径、右心室内径和肺动脉收缩压均比术前降低(P<0.05)，成形环组术后2年肺动脉收缩压仍有下降趋势(P<0.05)。成形环组术后6个月三尖瓣反流轻度以下者为100%，术后1年、2年未见三尖瓣反流加重病例；De Vega组术后6个月、1年、2年三尖瓣反流轻度以下者分别为83.3%、94.5%和88.9%，三尖瓣中度反流者分别为16.7%、4.5%和11.1%，无重度反流病例。结论应用三尖瓣成形环行三尖瓣环成形术，其近期效果优于De Vega成形术，但其远期效果还需进一步随访观察。
目的評價功能性三尖瓣中、重度關閉不全患者行人工環成形術和De Vega成形術後的近期臨床效果。方法2010年1月-2012年12月，我院行三尖瓣環成形術65例。根據手術方式分為2組：De Vega成形組(De Vega組)30例，人工環成形組(人工環組)35例。對所有患者在不同隨訪時間點採用超聲心動圖觀察術後三尖瓣的反流情況，比較兩組患者近期手術療效。結果術後兩組患者均無手術死亡；隨訪0.5-2.6年。術後心功能分級均較術前改善2-3級；術後6箇月，右心房內徑、右心室內徑和肺動脈收縮壓均比術前降低(P<0.05)，成形環組術後2年肺動脈收縮壓仍有下降趨勢(P<0.05)。成形環組術後6箇月三尖瓣反流輕度以下者為100%，術後1年、2年未見三尖瓣反流加重病例；De Vega組術後6箇月、1年、2年三尖瓣反流輕度以下者分彆為83.3%、94.5%和88.9%，三尖瓣中度反流者分彆為16.7%、4.5%和11.1%，無重度反流病例。結論應用三尖瓣成形環行三尖瓣環成形術，其近期效果優于De Vega成形術，但其遠期效果還需進一步隨訪觀察。
목적평개공능성삼첨판중、중도관폐불전환자행인공배성형술화De Vega성형술후적근기림상효과。방법2010년1월-2012년12월，아원행삼첨판배성형술65례。근거수술방식분위2조：De Vega성형조(De Vega조)30례，인공배성형조(인공배조)35례。대소유환자재불동수방시간점채용초성심동도관찰술후삼첨판적반류정황，비교량조환자근기수술료효。결과술후량조환자균무수술사망；수방0.5-2.6년。술후심공능분급균교술전개선2-3급；술후6개월，우심방내경、우심실내경화폐동맥수축압균비술전강저(P<0.05)，성형배조술후2년폐동맥수축압잉유하강추세(P<0.05)。성형배조술후6개월삼첨판반류경도이하자위100%，술후1년、2년미견삼첨판반류가중병례；De Vega조술후6개월、1년、2년삼첨판반류경도이하자분별위83.3%、94.5%화88.9%，삼첨판중도반류자분별위16.7%、4.5%화11.1%，무중도반류병례。결론응용삼첨판성형배행삼첨판배성형술，기근기효과우우De Vega성형술，단기원기효과환수진일보수방관찰。
Objectives Tricuspid valve(TV) insufficiency secondary to valvular heart disease or congenital heart disease is the most common aetiology of tricuspid regurgitation(TR). Appropriate treatment can improve long-term outcome. However, valve annuloplasty is the primary treatment for TV insufficiency. Our objective was to assess the short-term effectiveness of patients underwent tricuspid valve procedures for moderate or severe tricuspid regurgitation. These included De Vega suture tricuspid valve annuloplasty and ring annuloplasty. Methods A retrospective analysis of 65 consecutive patients with moderate to severe TR who underwent TV surgery between January 2010 and December 2012 with either a ring annuloplasty(Group Ring: n=35) or a De Vega suture annuloplasty (Group De Vega: n=30) at our hospital. The etiology for tricuspid regurgitation was rheumatic mitral and/or aortic valve diseases in 52 cases, adult atrial septal defect(ASD) in 13 cases. At different follow-up time point, the tricuspid regurgitation of all the patients was tested using ultrasound cardiography. The follow-up results were compared in 2 groups of patients. Results All patients survived from the operation. The follow up time was 0.5 to 2.6 years. The heart function improved to be NYHA class Ⅱ to Ⅲ in all patients. By 6 months after operation, right atrial diameter, right ventricle diameter and pulmonary artery systolic pressure in 2 groups was lower than the preoperative(P<0.05). However, by 2 years, pulmonary artery systolic pressure in ring group was still a downward trend(P<0.05). Echocardiography showed that trivial to mild TR was in all patients with ring annuloplasty after 6 months, and no moderate to severe TR war observed in one or two years later. By 0.5year, 1year and 2years follow up, echocardiography showed that trivial to mild TR was 83.3%, 94.5% and 88.9% respectively, and moderate TR was 16.7%, 4.5% and 11.1% respectively, but no severe TR cases in De Vega group. Conclusions In our experience, both De Vega annuloplasty suture and annuloplasty ring give satisfactory results, placement of an annuloplasty ring in patients undergoing tricuspid valve annuloplasty is significantly better than a De Vega's annuloplasty suture.The long-term effect still need further follow up.
