三種三尖瓣成形術治療三尖瓣返流近期療效分析_《中國修復重建外科雜志》

作者：

方智 , 蒙煒 , 張爾永

四川大學華西醫院心臟大血管外科（成都，610041）;

關鍵詞：

三尖瓣反流瓣環成形術 Kay成形術 DeVega成形術

DOI：

10.7507/1002-1892.20130269

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目的比較3種三尖瓣成形術治療三尖瓣反流術后近期反流程度的改善效果。方法2010年10 月－2011年6月，共納入148例風濕性心臟病行左心瓣膜置換手術同期行三尖瓣成形術患者。男32例，女116例；年齡15～66歲，平均47.5歲。根據三尖瓣成形術不同將患者分為3組：Cosgrove-Edwards成形環組（成形環組）58例、Kay成形組（Kay組）61例、DeVega成形組（DeVega組）29例。術前3組除三尖瓣反流程度（成形環組重于其余2組）、房顫及行射頻消融術比例（成形環組高于其余2組）比較差異有統計學意義（P lt; 0.05）外，其余一般資料比較差異均無統計學意義（P gt; 0.05），具有可比性。記錄3組患者圍手術期資料，根據紐約心臟病協會（NYHA）分級標準行心功能評價，心臟彩色超聲多普勒檢查記錄圍手術期及隨訪期間的三尖瓣反流程度。結果術后Kay組及成形環組各1例因發生低心排綜合征死亡。Kay組和成形環組分別有2例和1例患者發生肺部感染，成形環組有1例術后胸骨哆開再次手術，3組患者圍手術期并發癥發生率比較差異無統計學意義（P=0.840）。出院時3組患者三尖瓣反流程度均較術前顯著改善（P lt; 0.001）。146例患者獲隨訪，隨訪時間6～12個月，平均7.3個月。末次隨訪時3組患者心功能NYHA分級較術前均有所提高（P lt; 0.001），但3組心功能改善程度差異無統計學意義（χ2=0.120，P=0.942）。末次隨訪時，3組患者反流程度較術前有所改善（P lt; 0.001），且3組改善程度差異有統計學意義（χ2=26.827，P=0.000），成形環組術后反流改善程度明顯優于其余2組（P lt; 0.001），DeVega組與Kay組術后反流改善程度差異無統計學意義（Z=1.467，P=0.142）。結論采用三尖瓣軟質成形環成形術治療三尖瓣反流患者，其術后近期三尖瓣反流程度改善效果優于Kay成形術及DeVega成形術。

引用本文： 方智,蒙煒,張爾永. 三種三尖瓣成形術治療三尖瓣返流近期療效分析. 中國修復重建外科雜志, 2013, 27(10): 1230-1233. doi: 10.7507/1002-1892.20130269 復制

1.	Perier P, Jeserich M, Vieth M, et al. Mitral valve reconstruction in a patient with Libman-Sacks endocarditis: a case report. J Heart Valve Dis, 2011, 20(1): 103-106.
2.	Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart, 2012, 98(1): 24-30.
3.	Garatti A, Canziani A, Mossuto E, et al. Tricuspid valve replacement with mechanical prostheses: long-term results. J Heart Valve Dis, 2010, 19(2): 194-200.
4.	Shah PM, Raney AA. Tricuspid valve disease. Curr Probl Cardiol, 2008, 33(2): 47-84.
5.	Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
6.	Singh SK, Tang GH, Maganti MD, et al. Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease. Ann Thorac Surg, 2006, 82(5): 1735-1741.
7.	許建屏, 潘世偉, 葛翼鵬. 三尖瓣改良DeVega環縮術與人工軟環成形術效果比較. 中華胸心血管外科雜志, 2006, 22(2): 134-135.
8.	Carrier M, Pellerin M, Guertin MC, et al. Twenty-five years’ clinical experience with repair of tricuspid insufficiency. J Heart Valve Dis, 2004, 13(6): 952-956.
9.	Kim HK, Lee SP, Kim YJ, et al. Tricuspid regurgitation: clinical importance and its optimal surgical timing. J Cardiovasc Ultrasound, 2013, 21(1): 1-9.
10.	Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2012, 143(3): 632-638.
11.	Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
12.	胡佳, 康寧, 萬松. 外科修復功能性三尖瓣反流: 舊課題的新認識. 中國胸心血管外科臨床雜志, 2010, 17(6): 494-498.
13.	Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: Annulus, commissure, or leaflet procedure? J Thorae Cardiovasc Surg, 2010, 139(6): 1473-1482．.
14.	Khorsandi M, Banerjee A, Singh H, et al. Is a tricuspid annuloplastyring significantly better than a De Vega’s annuloplasty stitch when repairingsevere tricuspid regurgitation? Interact Cardiovasc Thorac Surg, 2012, 15(1): 129-135.
15.	Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2008, 118(15): e523-661.
16.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
17.	龐中一, 陸龍. 功能性三尖瓣反流的改良DeVega成形環縮術與經典DeVega環縮術療效分析. 醫學研究雜志, 2009, 38(4): 98-100.
18.	張嵬. 三尖瓣瓣環成形術臨床研究現狀. 河北北方學院學報: 醫學版, 2008, 25(2): 77-80.

1. Perier P, Jeserich M, Vieth M, et al. Mitral valve reconstruction in a patient with Libman-Sacks endocarditis: a case report. J Heart Valve Dis, 2011, 20(1): 103-106.
2. Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart, 2012, 98(1): 24-30.
3. Garatti A, Canziani A, Mossuto E, et al. Tricuspid valve replacement with mechanical prostheses: long-term results. J Heart Valve Dis, 2010, 19(2): 194-200.
4. Shah PM, Raney AA. Tricuspid valve disease. Curr Probl Cardiol, 2008, 33(2): 47-84.
5. Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
6. Singh SK, Tang GH, Maganti MD, et al. Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease. Ann Thorac Surg, 2006, 82(5): 1735-1741.
7. 許建屏, 潘世偉, 葛翼鵬. 三尖瓣改良DeVega環縮術與人工軟環成形術效果比較. 中華胸心血管外科雜志, 2006, 22(2): 134-135.
8. Carrier M, Pellerin M, Guertin MC, et al. Twenty-five years’ clinical experience with repair of tricuspid insufficiency. J Heart Valve Dis, 2004, 13(6): 952-956.
9. Kim HK, Lee SP, Kim YJ, et al. Tricuspid regurgitation: clinical importance and its optimal surgical timing. J Cardiovasc Ultrasound, 2013, 21(1): 1-9.
10. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2012, 143(3): 632-638.
11. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
12. 胡佳, 康寧, 萬松. 外科修復功能性三尖瓣反流: 舊課題的新認識. 中國胸心血管外科臨床雜志, 2010, 17(6): 494-498.
13. Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: Annulus, commissure, or leaflet procedure? J Thorae Cardiovasc Surg, 2010, 139(6): 1473-1482．.
14. Khorsandi M, Banerjee A, Singh H, et al. Is a tricuspid annuloplastyring significantly better than a De Vega’s annuloplasty stitch when repairingsevere tricuspid regurgitation? Interact Cardiovasc Thorac Surg, 2012, 15(1): 129-135.
15. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2008, 118(15): e523-661.
16. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
17. 龐中一, 陸龍. 功能性三尖瓣反流的改良DeVega成形環縮術與經典DeVega環縮術療效分析. 醫學研究雜志, 2009, 38(4): 98-100.
18. 張嵬. 三尖瓣瓣環成形術臨床研究現狀. 河北北方學院學報: 醫學版, 2008, 25(2): 77-80.

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《中國修復重建外科雜志》

三種三尖瓣成形術治療三尖瓣返流近期療效分析

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