【摘要】：目的比較三尖瓣成形術(shù)及三尖瓣置換術(shù)治療中重度三尖瓣關(guān)閉不全的術(shù)后早期及中期生存率和并發(fā)癥率,評價三尖瓣成形術(shù)與三尖瓣置換術(shù)治療中重度三尖瓣關(guān)閉不全的效果,為此類手術(shù)提供借鑒。方法回顧性分析2003年1月至2008年6月在我院住院治療的合并左心瓣膜疾病或者先天性心臟病的三尖瓣關(guān)閉不全患者,部分患者有雙下肢水腫、頸靜脈充盈、肝腫大等右心衰癥狀,給予改善心功能治療后行三尖瓣手術(shù)的患者228例,其中127例患者行三尖瓣成形術(shù),101例患者行三尖瓣置換術(shù)。收集圍手術(shù)期資料,并隨訪65個月,評價兩種手術(shù)方法治療合并右心衰竭的中重度三尖瓣關(guān)閉不全的效果。結(jié)果三尖瓣成形組,男性51例,女76例,平均年齡(57.97±9.24)歲,三尖瓣置換組,男性52例,女49例,平均年齡(57.87±9.35)歲。三尖瓣成形組術(shù)前三尖瓣中度反流68例,重度反流49例,三尖瓣置換組中度和重度反流分別為41例、60例。三尖瓣成形組術(shù)前心功能II級22例(17.3%)、III級79例(62.2%)、IV級26例(20.5%),三尖瓣置換組心功能II級、III級、IV級分別為11例(10.9%)、56例(55.4%)、34例(33.7%)。三尖瓣成形組術(shù)前肝功能異常率(4.4%)低于三尖瓣置換組(10.9%)(P=0.023),三尖瓣成形組術(shù)前平均肺動脈收縮壓(53.48±14.32)mmHg低于三尖瓣置換組(57.62±14.65)mmHg(P=0.033),余術(shù)前資料差異無統(tǒng)計學意義(P值均0.05);三尖瓣置換組患者平均主動脈阻斷時間、體外循環(huán)時間、呼吸機輔助時間及ICU停留時間、正性肌力藥物使用量明顯高于三尖瓣成形組患者,且有顯著性差異(P0.01);術(shù)后早期兩組患者在右心房右心室內(nèi)徑、左室射血分數(shù)及肺動脈收縮壓差異無統(tǒng)計學意義(P值均0.05),三尖瓣成形組術(shù)后早期并發(fā)癥例數(shù)20例,并發(fā)癥率為(15.75%)低于三尖瓣置換組并發(fā)癥例數(shù)27例,并發(fā)癥率(27.27%)(P=0.042);,三尖瓣成形組圍手術(shù)期死亡例數(shù)8例,死亡率(6.3%)低于三尖瓣置換組死亡17例,死亡率(16.83%)(P=0.011)。長期隨訪發(fā)現(xiàn)三尖瓣成形組三尖瓣中重度反流復發(fā)33例(28.7%)高于三尖瓣置換組7例(8.75%)(P=0.011);三尖瓣成形組心功能I級18例、II級88例、III級9例,三尖瓣置換組心功能I級、II級、III級分別為11例、59例、10例,差異無統(tǒng)計學意義(P值分別為0.713,0.659,0.279);三尖瓣成形組患者術(shù)后3月、1年、3年、5年生存率高于三尖瓣置換組,但差異無統(tǒng)計學意義(P分別為0.231,0.089,0.133,0.078)。結(jié)論在合并中重度三尖瓣關(guān)閉不全患者治療中,三尖瓣成形術(shù)早期治療效果優(yōu)于三尖瓣置換術(shù);三尖瓣成形術(shù)后中期三尖瓣中重度反流復發(fā)率高于三尖瓣置換術(shù)。
[Abstract]:Objective to compare the early and intermediate survival rate and complication rate of tricuspid valvuloplasty and tricuspid valve replacement in the treatment of moderate and severe tricuspid insufficiency, and to evaluate the effect of tricuspid valvuloplasty and tricuspid valve replacement in the treatment of moderate and severe tricuspid insufficiency. To provide reference for this kind of operation. Methods from January 2003 to June 2008, patients with tricuspid insufficiency complicated with left heart valve disease or congenital heart disease in our hospital were analyzed retrospectively. Some of the patients had edema of lower extremity and filling of jugular vein. 228 patients underwent tricuspid valve operation after cardiac function improvement, including 127 patients underwent tricuspid valve replacement and 101 patients underwent tricuspid valve replacement. The data of perioperative period were collected and followed up for 65 months to evaluate the efficacy of two surgical methods in the treatment of moderate and severe tricuspid insufficiency with right heart failure. Results the mean age of tricuspid valve replacement group was (57.97 鹵9.24) years old. There were 52 males and 49 females with mean age of (57.87 鹵9.35) years. There were 68 cases of moderate tricuspid regurgitation, 49 cases of severe regurgitation and 41 cases of moderate and severe regurgitation in tricuspid valve replacement group. In tricuspid valve replacement group, there were 22 cases (17.3%) with II grade III, 79 cases (62.2%) with II grade III and 26 cases (20.5%) with grade IV cardiac function. In tricuspid valve replacement group, there were 11 cases (10.9%) with II grade III and 34 cases (33.7%) with cardiac function. The abnormal rate of liver function in tricuspid valvuloplasty group (4.4%) was lower than that in tricuspid valve replacement group (10.9%) (P0. 023). The mean pulmonary arterial systolic pressure (PAP) in tricuspid valve plasty group was (53.48 鹵14.32) mmHg lower than that in tricuspid valve replacement group (57.62 鹵14.65) mmHg (P0. 033). Mean aortic occlusion time in the replacement group, The time of cardiopulmonary bypass (CPB), ventilator assisted time and ICU residence time were significantly higher than those in tricuspid valvuloplasty group (P0.01), the diameter of right atrium and right ventricle in the early postoperative group was significantly higher than that in tricuspid valvuloplasty group (P0.01). There was no significant difference in left ventricular ejection fraction (LVEF) and pulmonary systolic blood pressure (P < 0.05). There were 20 cases of early complications in tricuspid valve plasty group (15.75%) and 27 cases in tricuspid valve replacement group (P < 0.05). The complication rate was 27.27% (P0. 042). The mortality rate (6. 3%) in tricuspid valve plasty group was lower than that in tricuspid valve replacement group (17 cases) (16. 83%) (P0. 011). Long-term follow-up showed that 33 cases (28.7%) of tricuspid regurgitation in tricuspid valvuloplasty group were higher than 7 cases (8.75%) in tricuspid valve replacement group, and 9 cases in tricuspid valve replacement group (n = 18) had cardiac function grade I, grade II and grade III. In the tricuspid valve replacement group, the cardiac function grade I and II grade III were 11 cases and 59 cases respectively, the difference was not statistically significant (P = 0.713 0. 659 0. 279), the survival rate of 3 months, 1 year, 3 years and 5 years in the tricuspid valve replacement group was higher than that in the tricuspid valve replacement group, and the survival rate in the tricuspid valve replacement group was higher than that in the tricuspid valve replacement group. But the difference was not statistically significant (P = 0.231, 0.089, 0.133, 0.078, respectively). Conclusion tricuspid valvuloplasty is superior to tricuspid valve replacement in the treatment of patients with moderate and severe tricuspid insufficiency, and the recurrence rate of middle and severe tricuspid regurgitation after tricuspid valvuloplasty is higher than that of tricuspid valve replacement.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2

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