改良三尖瓣成形术的效果评价_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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王俊 , 陈亮 , 陈广明等

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Keywords：

三尖瓣成形术; Kay 成形术; 三尖瓣反流

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目的比较一种改良三尖瓣成形术与Kay 成形术的成形效果，总结治疗经验。方法回顾性分析江苏省人民医院2006 年1 月至2008 年1 月60 例功能性三尖瓣反流患者的临床资料。按手术方式不同将60 例患者分为两组：改良三尖瓣成形术组（改良组），30 例，其中男14 例，女16 例；年龄（42.80±5.70）岁；Kay 成形术组，30 例，其中男15 例，女15 例；年龄（45.30±8.30）岁。术前两组患者的年龄、性别、心功能分级（NYHA）和三尖瓣反流分级差异均无统计学意义（P ＞ 0.05)。比较两组患者术前、术后住院及术后随访期间的右心房横径、右心室舒张期末内径和三尖瓣反流面积。结果两组患者手术时间、体外循环时间、住重症监护室时间、呼吸机辅助时间、住院时间差异均无统计学意义。术后全部患者痊愈出院。改良组随访时间为（19.62±8.65）个月，远期1 例死于肺部感染；随访三尖瓣无反流13 例，Ⅰ级反流14 例，Ⅱ级反流2 例，Ⅲ级反流1 例，无Ⅳ级反流。Kay 成形术组随访时间为（18.96±9.23）个月，远期死亡2 例，分别死于顽固性右心衰竭和脑出血；随访无三尖瓣反流9 例，Ⅰ级反流12 例，Ⅱ级反流5 例，Ⅲ级反流2 例，Ⅳ级反流2 例。术后早期改良组和Kay 成形术组右心房横径[（4.51±0.85）cm vs. (5.69±1.21) cm]、右心室舒张期末内径[（2.85±0.45） cm vs.（ 3.47±0.83） cm] 和三尖瓣反流面积[（4.17±2.54） cm2 vs.（ 25.12±2.39 cm2）] 较术前均明显下降（P ＜ 0.05）；术后随访改良组和Kay成形术组右心房横径[（3.95±0.66） cm vs.（ 4.52±0.38） cm，P=0.705] 差异无统计学意义，右心室舒张期末内径[（2.59±0.63）cm vs.（ 2.98±0.47） cm， P=0.002] 和三尖瓣反流面积[（8.76±3.45） cm2 vs.（ 12.16±5.28） cm2， P=0.004] 改良组优于Kay 成形术组。结论改良三尖瓣成形术的远期成形效果优于Kay 成形术。

Citation： 王俊,陈亮,陈广明等. 改良三尖瓣成形术的效果评价. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 80-82. doi: Copy

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2.	Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease： incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5)：401-408.
3.	De Vega NG, De Rábago G, Castillón L, et al. A new tricuspid repair. Short-term clinical results in 23 cases. J Cardiovasc Surg (Torino), 1973, Spec No： 384-386.
4.	Kay GL, Morita S, Mendez M, et al. Tricuspid regurgitation associated with mitral valve disease： repair and replacement. Ann Thorac Surg, 1989, 48 (Suppl 3)： S93-S95.
5.	Raja SG. Dreyfus GD. Surgery for functional tricuspid regurgitation： current techniques, outcomes and emerging concepts. Expert Rev Cardiovasc Ther, 2009, 7(1)： 73-84.
6.	Lawrence SC, Gerald M, Ann FB, et al. Intraoperative evaluation of mitral regurgitation by doppler color flow mapping. Circulation, 1987, 76(3 Pt 2)：Ⅲ108-116.
7.	Lambertz H, Flachskampf FA, Minale C. Tricuspid regurgitation in patients with mitral valve disease： who need tricuspid repair? Circulation, 1998, 78(2)：210-211.
8.	Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2)：271-276.
9.	Sugimoto T, Okada M, Ozaki N, et al. Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume： characteristic difference based on primary cardiac lesion. J Thorac Cardiovasc Surg, 1999, 117(3)：463-471.
10.	Tei C, Pilgrim JP, Shah PM,et al. The tricuspid valve annulus： study of size and motion in normal subjects and in patients with tricuspid regurgitation. Circulation, 1982, 66(3)：665-671.
11.	Silver MD, Lam JH, Ranganathan N, et al. Morphology of the human tricuspid valve. Circulation, 1971, 43(3)：333-348.
12.	McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3)：674-685.
13.	Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilation： Which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1)：127-132.
14.	Xiao XJ, Huang HL, Zhang JF, et al. Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1)：65-69.
15.	Porter A, Shapia Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement clinical an echocardiography evaluation. J Heart Valve Dis, 1999, 8(1)：57-62.

1. 　Frater R. Tricuspid insufficiency. J Thorac Cardiovasc Surg, 2001, 122(3)：427-429.
2. 　Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease： incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5)：401-408.
3. 　De Vega NG, De Rábago G, Castillón L, et al. A new tricuspid repair. Short-term clinical results in 23 cases. J Cardiovasc Surg (Torino), 1973, Spec No： 384-386.
4. 　Kay GL, Morita S, Mendez M, et al. Tricuspid regurgitation associated with mitral valve disease： repair and replacement. Ann Thorac Surg, 1989, 48 (Suppl 3)： S93-S95.
5. 　Raja SG. Dreyfus GD. Surgery for functional tricuspid regurgitation： current techniques, outcomes and emerging concepts. Expert Rev Cardiovasc Ther, 2009, 7(1)： 73-84.
6. 　Lawrence SC, Gerald M, Ann FB, et al. Intraoperative evaluation of mitral regurgitation by doppler color flow mapping. Circulation, 1987, 76(3 Pt 2)：Ⅲ108-116.
7. 　Lambertz H, Flachskampf FA, Minale C. Tricuspid regurgitation in patients with mitral valve disease： who need tricuspid repair? Circulation, 1998, 78(2)：210-211.
8. 　Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2)：271-276.
9. 　Sugimoto T, Okada M, Ozaki N, et al. Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume： characteristic difference based on primary cardiac lesion. J Thorac Cardiovasc Surg, 1999, 117(3)：463-471.
10. 　Tei C, Pilgrim JP, Shah PM,et al. The tricuspid valve annulus： study of size and motion in normal subjects and in patients with tricuspid regurgitation. Circulation, 1982, 66(3)：665-671.
11. 　Silver MD, Lam JH, Ranganathan N, et al. Morphology of the human tricuspid valve. Circulation, 1971, 43(3)：333-348.
12. 　McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3)：674-685.
13. 　Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilation： Which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1)：127-132.
14. 　Xiao XJ, Huang HL, Zhang JF, et al. Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1)：65-69.
15. 　Porter A, Shapia Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement clinical an echocardiography evaluation. J Heart Valve Dis, 1999, 8(1)：57-62.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

改良三尖瓣成形术的效果评价

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