不同三尖瓣成形术治疗风湿性二尖瓣病变合并三尖瓣关闭不全临床研究

目的:比较行不同成形术治疗风湿性二尖瓣病变合并功能性三尖瓣关闭不全的外科疗效。方法:选取风湿性二尖瓣病变合并功能性三尖瓣关闭不全患者119例,按照治疗方法将患者分为对照组、三尖瓣人工环植入成形术组(成形环组)以及三尖瓣缝线成形术(缝线组),分别统计患者年龄、性别、手术方式、术前及术后心功能分级等指标,采用t检验对患者术前、术后2周以及术后6个月心脏各腔内径进行统计学分析。结果:患者行三尖瓣人工环植入成形术以及三尖瓣缝线成形术治疗后,心脏各腔内径均明显缩小,成形环组患者术后心脏内径缩小最显著,行三尖瓣缝线成形术患者次之。术前成形环组左心房、右心房以及右心室内径较对照组扩大明显(P0.05);术前缝线组左心房、右心房以及右心室内径较对照组扩大明显(P0.05);术前成形环组与缝线组右心房、右心室内径组间无明显差异;术后2周以及术后6个月三组间左心房内径无明显差异(P0.05)。术后2周成形环组以及缝线组右心房以及右心室内径仍大于对照组(P0.05),术前成形环组与缝线组组间无显著差异。术后6个月成形环组右心房以及右心室内径较缝线组显著缩小(P0.05),成形环组和对照组间无明显差异。结论:治疗风湿性二尖瓣病变合并功能性三尖瓣关闭不全的方法中,三尖瓣人工环植入成形术效果优于三尖瓣缝线环缩术。

Clinical Study of Early Surgical Treatment for Patients with Moderate or Severe Tricuspid Insufficiency Secondaryto RheumaticMitral Valve Disease

Objective:To compare the different surgical procedures for treating moderate and severe tricuspid insufficiency secondary to rheumatic mitral valve malfunction.Methods:One hundred and nineteen patients who underwent the mitral valve surgery with rheumatic heart disease were enrolled in the study, patients without tricuspid regurgitation or with mild tricuspid regurgitation were subjected to the control group, the rest patients were subjected to suture annuloplasty group and artificial valve ring annuloplasty group. The clinical data of the patients were collected, the results of cardiac ultrasonography, hepatic and renal function, and the age, sex, preand intro- operative data, etc were then analyzed.Results:The postoperative diameters of heart were decreased obvious in the three groups, and post-operative diameters of heart were decreased obvious in the artificial valve ring annuloplasty group than the suture annuloplasty group. The pre-operative diameterof left atrial (LAD), (RAD) and (RVD) enlarged obvious in the suture annuloplasty group and artificial valve ring annuloplasty group compared with the control group (P<0.05). There was no difference in the artificial valve ring annuloplasty group and control group. The post-operative (two-week) and post-operative (six-month) diameter of LAD have no difference in the three groups (P>0.05). The pre-operative diameter of RAD and RVD enlarged obvious in the suture annuloplasty group and artificial valve ring annuloplasty group compared with the control group (P<0.05). But the post-operative (six-month) diameter of RAD and RVD have great different between the artificial valve ring annuloplasty group and the suture annuloplasty group (P<0.05), there was no difference in the artificial valve ring annuloplasty group and control group (P>0.05).Conclusion:The artificial valve ring annuloplasty is superior to the suture annuloplasty for the treatment of the moderate or severe tricuspid regurgitation secondary to rheumatic mitral valve malfunction patients.