摘要
目的比较针对功能性三尖瓣关闭不全(TR)所采取不同成形方法的临床中、远期效果。方法手术治疗功能性TR 237例,均为合并左心系统瓣膜病变,行左心瓣膜手术时同期行三尖瓣成形术。其中采用不上成形环方法的共178例,行单纯缝线瓣环成形,置入成形环的共59例;同期所行左心瓣膜手术包括二尖瓣置换(MVR)136例、二尖瓣成形(MVP)21例、MVR+主动脉瓣置换(AVR)71例,冠脉旁路移植(CABG)+MVR 6例、CABG+MVP2例。观察比较术后1.5年及3.5年或以上两组病人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209人(88.2%)完成长期随访(3.5年或以上)。术后1.5年发现中度以下再发性TR两组差别无显著性(P=0.23),中重度者上环组明显低于非上环组(P=0.028)。远期随访发现上环组TR再发性率明显低于非上环组(P=0.034),发展为中度以上TR的比率非上环组显著地高于上环组(P=0.007)。组内两个时间段相比,非上环组TR进展明显增快(P=0.016),而上环组相对稳定(P=0.60)。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的处理应采取更加积极的态度。
Objective To compare the mid-and long-term results of tricuspid valve（TV） repair with or without an annuloplasty ring.Methods Totally 237 patients underwent TV repair at our division（2001 to 2008）,of which 178 had,predominantly,a De Vega Or Kay procedure（no ring） and 59 had an annuloplasty ring（ring）.TV pathology mainly was functional（secondary） and several with rheumatic leaflets involvement.Concomitant procedures consisted of mitral valve surgery in 100% of patients,aortic valve surgery in 71,and coronary bypass in 8.Clinical and echocardiographic follow-up data were obtained.Results Postoperationally,the mid-term（1.5years） follow-up was 100% complete and the long-term follow-up was 88.2% complete（3.7±2.8） years long.Regurgitation severity was stable across time with the ring patients（P=0.60）,increased remarkablly with the non-ring patients（P=0.016）,and in the same stage,the ratio of recurrently moderate to severe tricuspid valve regurgitation（TR） was significantly different（P=0.028 in the 1.5years follow-up and P=0.007 in the 3.5 years or over respectively）,and freedom from recurrent TR were better in the ring group.Conclusion Placement of an annuloplasty ring in patients undergoing tricuspid valve repair is associated with remarkablly improved results.In clinic practice,we should be more aggressive to the functional TR and preferring to the procedure with annuloplasty ring.
出处
《医药论坛杂志》
2010年第18期32-33,36,共3页
Journal of Medical Forum
关键词
三尖瓣关闭不全三尖瓣成形术人工成形环
Tricuspid Valve Regurgitation
Tricuspid Valve Annuloplasty
Artificial annuloplasty ring
