冠心病合并缺血性二尖瓣关闭不全的手术方案探讨

目的:探讨适用于冠心病合并缺血性二尖瓣关闭不全的手术方法及临床效果,为心外科手术提供参考。方法:选取2012年2月至2013年5月在我院心脏外科接受手术治疗的冠心病合并缺血性二尖瓣关闭不全的患者31例。根据手术方式的不同,将所选病例分为二尖瓣成形术组和二尖瓣置换术组。术后随访6-24个月,观察并比较患者手术前后的左心房内径(LAD)、舒张末期直径(LVEDD)、收缩末期直径(LVESD)、左心室射血分数(LVEF)及二尖瓣返流面积。结果:围术期死亡1例,手术成功率为96.7%。30例成功获得随访,随访率为98.8%。二尖瓣成形术组并发症的发生率为22.7%,二尖瓣置换术组并发症的发生率为23.3%,两组术后并发症的发生率无显著差异(P0.05)。与手术前相比,两组患者术后的左心房内径变小,左室舒张末直径和收缩末直径增加,左室射血分数升高,二尖瓣反流面积缩少,差异显著且具有统计学意义(P0.05)。结论:对于冠心病合并重度缺血性二尖瓣关闭不全的患者行二尖瓣成形术或置换术应根据患者的实际情况和病理特点选择最佳的手术方案,以提高手术的成功率和安全性。

Discussion about the Operation Modes for Patients with the CoronaryHeart Disease and Ischemic Mitral Insufficiency

Objective:To explore the clinical effects of suitable surgical methods for patients with the coronary heart disease(CHD) and the ischemic mitral insufficiency so as to provide a reference for cardiac surgery.Methods:31 patients with heart disease(CHD) and ischemic mitral insufficiency who were taken the surgery in our hospital from February 2012 to May 2013 were selected anddivided into the mitral valvuloplasty group and the MVR (mitral valve replacement) group on the basis of different operation methods.Then the function of left heart were detected by UCG, and the LAD, LVEDD, LVESD, LVEF and the area of mitral valve of patientswere observed and compared before and after the surgery.Results:Only one died on the perioperative time with the surgical success rateof 96.7%. The incidence of complications was 22.7%in the mitral valvuloplasty group and 23.3%in the mitral valve replacement groupwith no statistically significant difference (P>0.05). When comparing with before, the LAD diminished, the LVEDD and LVESDincreased, the LVEF lightened and the area of mitral valve decreased with statistically significant differences (P<0.05).Conclusion:It issuggested that the selection of surgery should be well considered on the basis of the conditions and pathological characteristics of patientswith coronary heart disease in order to improve the success rate and safety of the surgery.