二尖瓣成形术与二尖瓣生物瓣置换术治疗风湿性二尖瓣重度关闭不全的效果比较

目的:探讨二尖瓣成形术(Mitral valve plasty,MVP)与二尖瓣生物瓣置换术(Mitral valve replacement,MVR)治疗风湿性二尖瓣重度关闭的临床疗效和安全性。方法:选择我院2014年1月至2019年1月收治的因风湿性二尖瓣重度关闭而行二尖瓣成形术或二尖瓣生物瓣置换术的患者60例,其中二尖瓣成形术组(MVP组)27例,二尖瓣生物瓣置换术组(MVR组)33例。比较两组患者的围手术期各项指标,治疗前后的心功能指标(左心室射血分数,左心房内径、左心室收缩末期内径、左心室舒张末期内径)及二尖瓣反流情况以及术后并发症的发生情况。结果:(1)MVP组患者的手术时间、体外循环时间均明显长于MVR组(P0.05);而术中出血量、呼吸机使用时间、住院时间MVP组均显著低于MVR组(P0.05);(2)术后,MVP组的LVEF和LVEDD水平高于MVR组,而LAD和LVESD水平则低于MVR组(P 0.05);(3)出院前及末次随访时,MVP组二尖瓣反流发生率与MVR组相比差异均无统计学意义(P0.05)。(4)MVP组患者的术后并发症发生率低于MVR组(P 0.05)。结论:二尖瓣成形术治疗风湿性二尖瓣重度关闭的临床疗效和安全性优于二尖瓣生物瓣置换术,但术者需严格掌控MVP的手术适应症。

Comparison of the Effect of Mitral Valve Plasty and Mitral Valve Replacement on the Severe Rheumatic Mitral Valve Insufficiency

ABSTRACT Objective: To investigate the clinical efficacy and safety of mitral valve plasty (MVP) and mitral valve replacement (MVR) in the treatment of severe mitral valvular closure. Methods: 60 patients with mitral valve plasty or mitral valve biological flap replacement were selected in our hospital from January 2014 to January 2019 due to severe closure of rheumatic mitral valve. There were 27 patients in the group (MVP group) and 33 patients in the mitral valve biopsy group (MVR group). The perioperative indicators of the two groups were compared, and the cardiac function indexes (left ventricular ejection fraction, left atrium diameter, left ventricular systolic end diameter, left ventricular diastolic end diameter) and mitral valve reflux were detected before and after treatment, and the postoperative complications were compared. Results: The operation time and extracorporeal circulation time of MVP group were longer than that in the MVR group (P<0.05), while the intraoperative blood loss, ventilator use time and hospitalization time were lower than that in the MVR group (P<0.05). Before operation, there was no significant difference in cardiac function between the two groups (P>0.05). After operation, the LVEF and LVEDD levels in the MVP group were higher than that in the MVR group, while the LAD and LVESD levels were lower than that in the MVR group (P<0.05). The incidence of mitral valve reflux in the MVP group was not statistically significant compared with that in the MVR group before and at the last follow-up (P>0.05). The incidence of postoperative complications in the MVP group was lower than that in the MVR group (P<0.05). Conclusion: The clinical efficacy and safety of mitral valvuloplasty for the treatment of severe rheumatic mitral regurgitation is better than that of mitral valve bioprosthetic replacement, and the postoperative cardiac function and other indexes are better and have fewer complications. However, the surgeon must strictly control the surgical indications of MVP.