130例二尖瓣置换术同期行三尖瓣成形术的方法及意义

664·上海第二医科大学学报AcademicJournalofShanghaiSet‘ondMedicalUniversity【文章编号】0258—5898(2004)08—0664—03130例二尖瓣置换术同期行三尖瓣成形术的方法及意义臧国辉。陈长志。郑家豪。周嘉(上海第二医科大学仁济医院胸心外科，上海200001)·临床研究·【摘要】目的探讨二尖瓣置换术(MVR)同期行三尖瓣成形术(TVP)的手术方法和意义。方法191例二尖瓣病变同时伴有功能性三尖瓣关闭不全(T1)的患者，其中130例于MVR手术同期行TVP。70例轻度Tl中，有7例行Kay氏法二瓣化成形术，2例行DeVega瓣环成形术；中度和重度Tl均同期行TVP其中中度Tl92例，行DeVega瓣环成形术57例，Kay氏法二瓣化成形术33例，人工瓣环固定术2例；重度Tl29例，行DeVega瓣环成形术6例，人工瓣环固定术23例。结果130例中死亡3例，127例康复出院。122例随访29～112月，发现32例有轻度或极轻度三尖瓣返流(TR)，7例中度TR，3例重度TR。结论二尖瓣病变同时伴有功能性Tl的患者，在施行MVR同时，应行TVP，尤其是中重度Tl更要积极处理。选择适当的手术方式，能有效纠正T1．阻止轻度TR加重，减少严重TR的发生率。【关键词】二尖瓣置换术；功能性三尖瓣关闭不全；三尖瓣成形术【中图分类号】R654．2【文献标识码】AMethodsandsignificanceofmitralvalvereplacementconcomitantwithtricuspidvalveplastyin130patientsZANGGuo-hui，CHENChang-zhi，ZHENGJia-hao，ZHOUJia(DepartmentofCardiothoracicSurgery，RenjiHospital，ShanghaiSecondMedicalUniversity，Shanghai200001，China)Abstract：ObjectiveToevaluatetheclinicalmethodsandvaluesofthemitralvalvereplacement(MVR)andtricuspidvalveplasty(TVP)．MethodsFourhundredseventypatientsunderwentMVR．Amongthem．191pa-tientshadfunctionaltricuspidinsufficiency(TI)，amongthem，70patientswithmildTI，92withmoderateTIand29withsevereTI．SevenpatientsunderwentKay’Sbicuspidvalvuloplastyand2withmildTIDeVegaannuloplasty．InmoderateTIpatients57underwentDeVegaannuloplasty，33Kay’Sbicuspidvalvuloplasty，andaaificialtricuspidringswereusedin2patients．InsevereTIpatients6hadDeVegaannuloplasty，and23artificialrings．ResuhsThreepatientsdiedand127patientsrecoveredpostoperatively．Onehundredandtwentytwosurvivorswere~llowedupfrom29to112months．Amongthem，32hadmildortrivial7moderatetricuspidregurgitation(TR)and3severeTR．ConclusionPropersurgicaltechniqueofTVPcouldeffectivelycorrectTI，preventthedevelopmentofmildTRanddecreasepostoperativeoccurranceofsevereTR．ModerateandsevereTIshouldbetreatedpositively．Keywords：mitralvalvereplacement；functionaltricuspidregurgitation：tricuspidvalveplasty在风湿性二尖瓣膜病变中，同时伴功能性三尖瓣关闭不全(tricuspidinsufficiency，TI)较多见。于二尖瓣置换术(mitralvaluereplacement，MVR)同时正确地纠治TI，能有效地预防术后因三尖瓣返流(tri—cuspi