22例保留前瓣叶的二尖瓣膜置换术疗效观察(1)
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[摘要] 目的：评估二尖瓣置换术中保留前瓣叶及其腱索对左心室功能的影响。方法：48例患者均在体外循环下进行二尖瓣置换手术，其中22例保留了二尖瓣前叶及其腱索(观察组)，26例未保留瓣叶及其腱索(对照组)。采用超声心动图评估测量两组患者术前和术后1个月左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)和左心室射血分数(LVEF)等变化。结果：观察组无手术早期死亡病例；对照组手术早期死亡1例(3.8%, 1/26)，超声心动图显示，两组LVEDV、LVESV均较术前明显缩小(P<0.05)，LVEF较术前明显提高(P<0.05)。结论：保留前瓣及其腱索的二尖瓣置换术对左心室功能的改善优于传统不保留瓣膜的二尖瓣置换术。
[关键词] 二尖瓣置换术；前瓣叶；保留
[中图分类号] R654.2[文献标识码]A [文章编号]1673-7210(2011)07(c)-039-02
The clinical observation of 22 preservation anterior leaflet with the chordae in mitral valve replacement
ZHU Yi, FANG Liangwei, TIAN Xiaofeng, GONG Li
Department of Cardiothoracic Surgery, the Affiliated Second People′s Hospital of Huai'an City, Xuzhou Medical College,Jiangsu Province,Huai′an 223002, China
[Abstract] Objective: To evaluate the effect of preservation anterior leaflet with the chordae to left ventricular function in mitral valve replacement. Methods: 48 patients in two groups were all performed mitral valve replacement under extracorporeal circulation, in which 22 cases reserved anterior leaflet with the chordae (observation group), and the other 26 cases were not reserved (control group). Then evaluated the change of LVEDV, LVESV and LVEF of two groups in pre-operation and 1 month after post-operation by echocardiography. Results: There were no early operative death in observation group, and only one operative death in control group. The echocardiography showed LVEDV and LVESV were decreased significantly, and LVEF was significantly enhanced than pre-operation in two groups (P<0.05). Conclusion: The preservation anterior leaflet with the chordae in mitral valve replacement can improve left ventricular function compared with the traditonal mitral valve replacement.
[Key words] Mitral valve replacement; Anterior leaflet; Preservation
二尖瓣人工瓣膜置换手术是心外科开展的常规心脏手术，现开展的换膜手术大多数不保留瓣叶或者仅仅保留较小的带腱索的后瓣。研究表明心室瓣环的不完整，对术后左心室的功能恢复非常不利。如何保留瓣叶及其腱索，保护术后左心室的功能成为非常重要的关注点。2008年1月～2010年12月笔者共对48例瓣膜病患者分别施行了二尖瓣置换手术，其中22例保留了二尖瓣前叶及其腱索，26例未保留瓣叶及其腱索，术后对两组患者的疗效进行了比较。现报道如下：
1 资料与方法
1.1一般资料
48例二尖瓣关闭不全患者，其中，男18例，女30例；年龄44～78岁，平均61.5岁。风湿性病变36例，黏液样变性12例；36例合并三尖瓣返流，16例合并主动脉瓣狭窄伴关闭不全；NYHA心功能Ⅱ级32例，Ⅲ级15例，Ⅳ级1例。
1.2 方法
手术均在全麻低温体外循环下进行 ......
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