中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
5期
705-711
,共7页
韩劲松%王辉山%尹宗涛%韩宏光%宋恒昌
韓勁鬆%王輝山%尹宗濤%韓宏光%宋恆昌
한경송%왕휘산%윤종도%한굉광%송항창
实验动物%组织构建%退行性病变%二尖瓣成形术%人工腱索%人工瓣环
實驗動物%組織構建%退行性病變%二尖瓣成形術%人工腱索%人工瓣環
실험동물%조직구건%퇴행성병변%이첨판성형술%인공건색%인공판배
transplantation%mitral valve regurgitation%mitral valve annuloplasty%chordae tendineae
背景：人工腱索移植是二尖瓣成形的难点，瓣环环缩也是二尖瓣成形术式中的关键步骤之一，而目前国内相关此类治疗方法的安全性、有效性和中期疗效的较大样本报道较少。<br> 目的：总结二尖瓣人工腱索移植和马鞍环环缩技术治疗退行性二尖瓣关闭不全的有效性和安全性。<br> 方法：2009年1月至2013年5月间解放军沈阳军区总医院心血管外科应用人工腱索移植和马鞍环环缩技术治疗退行性二尖瓣关闭不全患者85例。用Gore-Tex缝线作为人工腱索，马鞍环用SJMTM刚性鞍形成形环。共行人工腱索移植41例、人工腱索移植+后叶楔形切除21例、人工腱索移植+后叶楔形切除+Sliding技术23例。均行人工瓣环环缩术。<br> 结果与结论：治疗后随访78例，随访率为91.7%(78/85)。随访时间为6个月-4年。78例中，1例于治疗后13个月死于脑梗死，1例死于交通事故，余76例均存活。NYHA心功能分级Ⅰ级59例，Ⅱ级17例。复查心脏彩超示微量及以下反流67例，轻度反流9例。超声心动图显示左心房直径明显减少(P<0.05或P<0.01)，左心室舒张末期内径明显减少(P<0.05或P<0.01)，左心室收缩末期内径明显减少(P<0.05或P<0.01)，反流速面积/左房面积明显减少(P<0.05或P<0.01)，肺动脉平均压明显降低(P<0.05或P<0.01)，射血分数明显增加(P<0.05或P<0.01)。未出现二尖瓣收缩期前向运动现象(SAM征)。并发症情况：治疗后出现窦性心动过缓12例，阵发性室上性心动过速25例。1例治疗前伴快-慢综合征患者，治疗后安装永久起搏器。1例治疗后1周出现延迟性心包填塞，经心包穿刺置管引流后治愈。无成形环断裂或撕脱、无溶血、左室流出道梗塞、人工腱索断裂或劈裂发生。无再次手术行瓣膜置换患者。结果可见二尖瓣人工腱索移植和马鞍环环缩治疗退行性二尖瓣关闭不全安全、有效，近中期疗效满意。
揹景：人工腱索移植是二尖瓣成形的難點，瓣環環縮也是二尖瓣成形術式中的關鍵步驟之一，而目前國內相關此類治療方法的安全性、有效性和中期療效的較大樣本報道較少。<br> 目的：總結二尖瓣人工腱索移植和馬鞍環環縮技術治療退行性二尖瓣關閉不全的有效性和安全性。<br> 方法：2009年1月至2013年5月間解放軍瀋暘軍區總醫院心血管外科應用人工腱索移植和馬鞍環環縮技術治療退行性二尖瓣關閉不全患者85例。用Gore-Tex縫線作為人工腱索，馬鞍環用SJMTM剛性鞍形成形環。共行人工腱索移植41例、人工腱索移植+後葉楔形切除21例、人工腱索移植+後葉楔形切除+Sliding技術23例。均行人工瓣環環縮術。<br> 結果與結論：治療後隨訪78例，隨訪率為91.7%(78/85)。隨訪時間為6箇月-4年。78例中，1例于治療後13箇月死于腦梗死，1例死于交通事故，餘76例均存活。NYHA心功能分級Ⅰ級59例，Ⅱ級17例。複查心髒綵超示微量及以下反流67例，輕度反流9例。超聲心動圖顯示左心房直徑明顯減少(P<0.05或P<0.01)，左心室舒張末期內徑明顯減少(P<0.05或P<0.01)，左心室收縮末期內徑明顯減少(P<0.05或P<0.01)，反流速麵積/左房麵積明顯減少(P<0.05或P<0.01)，肺動脈平均壓明顯降低(P<0.05或P<0.01)，射血分數明顯增加(P<0.05或P<0.01)。未齣現二尖瓣收縮期前嚮運動現象(SAM徵)。併髮癥情況：治療後齣現竇性心動過緩12例，陣髮性室上性心動過速25例。1例治療前伴快-慢綜閤徵患者，治療後安裝永久起搏器。1例治療後1週齣現延遲性心包填塞，經心包穿刺置管引流後治愈。無成形環斷裂或撕脫、無溶血、左室流齣道梗塞、人工腱索斷裂或劈裂髮生。無再次手術行瓣膜置換患者。結果可見二尖瓣人工腱索移植和馬鞍環環縮治療退行性二尖瓣關閉不全安全、有效，近中期療效滿意。
배경：인공건색이식시이첨판성형적난점，판배배축야시이첨판성형술식중적관건보취지일，이목전국내상관차류치료방법적안전성、유효성화중기료효적교대양본보도교소。<br> 목적：총결이첨판인공건색이식화마안배배축기술치료퇴행성이첨판관폐불전적유효성화안전성。<br> 방법：2009년1월지2013년5월간해방군침양군구총의원심혈관외과응용인공건색이식화마안배배축기술치료퇴행성이첨판관폐불전환자85례。용Gore-Tex봉선작위인공건색，마안배용SJMTM강성안형성형배。공행인공건색이식41례、인공건색이식+후협설형절제21례、인공건색이식+후협설형절제+Sliding기술23례。균행인공판배배축술。<br> 결과여결론：치료후수방78례，수방솔위91.7%(78/85)。수방시간위6개월-4년。78례중，1례우치료후13개월사우뇌경사，1례사우교통사고，여76례균존활。NYHA심공능분급Ⅰ급59례，Ⅱ급17례。복사심장채초시미량급이하반류67례，경도반류9례。초성심동도현시좌심방직경명현감소(P<0.05혹P<0.01)，좌심실서장말기내경명현감소(P<0.05혹P<0.01)，좌심실수축말기내경명현감소(P<0.05혹P<0.01)，반류속면적/좌방면적명현감소(P<0.05혹P<0.01)，폐동맥평균압명현강저(P<0.05혹P<0.01)，사혈분수명현증가(P<0.05혹P<0.01)。미출현이첨판수축기전향운동현상(SAM정)。병발증정황：치료후출현두성심동과완12례，진발성실상성심동과속25례。1례치료전반쾌-만종합정환자，치료후안장영구기박기。1례치료후1주출현연지성심포전새，경심포천자치관인류후치유。무성형배단렬혹시탈、무용혈、좌실류출도경새、인공건색단렬혹벽렬발생。무재차수술행판막치환환자。결과가견이첨판인공건색이식화마안배배축치료퇴행성이첨판관폐불전안전、유효，근중기료효만의。
BACKGROUND:Artificial chordae transplantation and saddle ring annuloplasty are the key steps in mitral valvuloplasty. However, there are no large-size studies addressing the safety, validity and efficacy of these treatments in China. <br> OBJECTIVE:To summarize the efficacy and safety of artificial chordae transplantation and saddle ring annuloplasty in the treatment of degenerative mitral regurgitation. <br> METHODS:Eighty-five patients with degenerative mitral regurgitation underwent mitral valve repair with artificial chordae (Gore-Tex sutures) transplantation and saddle ring (SJMTM rigid saddle-shaped) annuloplasty from January 2009 to May 2013 in General Hospital of Shenyang Area Military Command, China. Operative technique included simple artificial chordae transplantation in 41 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet in 22 cases, artificial chordae transplantation plus quadrangular resection of the posterior leaflet and sliding technique in 23 cases. Al cases received saddle ring annuloplasty. <br> RESULTS AND CONCLUSION:Fol ow-up after treatment was done among 78 patients for 6 months to 4 years, with a fol ow-up rate of 91.7%(78/85). Among the 78 cases, one case died of cerebral infarction after 13 months, one died from accident, and the remaining 76 were alive. According to the evaluation of cardiac function (NYHA), 59 cases were in grade I and 17 cases were in grade II. Color ultrasound displayed that, no regurgitation was found in 67 cases, and mild regurgitation in 9 cases. The echocardiography showed that postoperative left atrium diameter (P<0.05 or P<0.01), left ventricular end-diastolic diameter (P<0.05 or P<0.01), left ventricular end-systolic diameter (P<0.05 or P<0.01), and the ratio of regurgitation beam area and left atrial area (P<0.05 or P<0.01), mean pulmonary artery pressure (P<0.05 or P<0.01) were significantly decreased compared with that before operation. Ejection fraction was significantly increased after operation (P<0.05 or P<0.01). No systolic anterior motion occurred. The postoperative complications included sinus bradycardia in 12 cases and paroxysmal supraventricular tachycardia in 25 cases, late cardiac tamponade in 1 case at 1 week postoperatively, and pacemarker implantation in 1 case (who exhibited bradycardia-tachycardia syndrome before operation). There was no ring rupture, ring avulsion, hemolysis, left ventricular outflow tract infarction and artificial chordae rupture or splitting. No cases needed reoperation on valve replacement. Application of artificial chordae transplantation and saddle ring annuloplasty is a safe and effective means for treating degenerative mitral regurgitation, with excellent midterm outcomes.
