二尖瓣替换术保留瓣叶及瓣下结构76例.docVIP

二尖瓣替换术保留瓣叶及瓣下结构76例 　 作者：戴炳光，郭兆源，曲崎，张敬国，张峰，李雪莲 【摘要】 目的 总结保留瓣叶和瓣下结构的二尖瓣置换手术的效果。方法 76例中男29例，女47例，年龄13～60岁，平均（50±9）岁，心功能Ⅱ级3例，Ⅲ级63例，Ⅳ级10例。手术采用全麻中度低温体外循环下手术。转流时间56～186 min，平均（76±18）min。主动脉阻断时间25～148 min，平均（51±16）min。结果 随访3个月～6年，死亡1例（术后6个月死于脑出血），脑血栓2例，3例因为风湿活动造成卡瓣而二次手术换瓣。心功能正常34例，Ⅱ级37例，Ⅲ级5例。结论 保留二尖瓣装置的二尖瓣替换术效果良好，但年龄小于45岁的风湿性患者，建议不保留瓣膜和瓣下结构，应该完全切除。 【关键词】 二尖瓣狭窄；二尖瓣闭锁不全；外科手术 Seventy-six cases of mitral valve replacement with leaflet and subvalvular apparatus preserved ［Abstract］ Objective To summarize the effect of mitral valve replacement with leaflet and subvalvular apparatus preserved.Methods Of the 76 cases，29 were male and 47 female.Their age ranged from 13 to 60 （mean 50±9） years old.In terms of heart function，three patients got grade 2，63 patients got grade 3，and ten patients got grade 4.General anesthesia and middling microtherm extracorporeal circulation were applied in the operation，the total extracorporeal circulation lased 56～186 minutes ［mean（76±18）mins］，and the artery arresting time was 25～148 minutes ［mean（51±16）mins］.Results Follow-up study was carried out 3 months after operation and lasted to the 6th year.One patient died of cerebral hemorrhage half a year after operation；two cases suffered from cerebral thrombosis and 3 cases had mitral valve replacement the second time as a result of blocked valve caused by active rheumatism.Thirty-four patients had normal heart function，37 cases had grade 2 heart function and 5 cases had grade 3.Conclusion The results of mitral valve replacement with mitral apparatus perserved are satisfactory，but we suggest that the valve and subvalvular apparatus of rheumatism patients younger than 45 should be removed rather than preserved. ［Key words］ mitral valve stenosis；mitral valve insufficiency；surgical procedures 我院2000年1月～2005年6月施行保留二尖瓣装置的二尖瓣替换术76例，效果良好。但对年轻的风湿性心脏病患者，应该慎用，现分析报告如下。 1 临床资料 1.1 一般资料 本组76例，男29例，女47例。体重40～85 kg，平均（60.8±13.5）kg。年龄13～60岁，平均（50±9）岁。风湿性心脏病33例，其中二尖瓣狭窄（MS）9例，二尖瓣狭窄并二尖瓣关闭不全（MS+MI）16例，二尖瓣、主动脉瓣双瓣病变8例，全