改良锥形重建法三尖瓣下移畸形矫治术

发布时间：2018-04-26 08:21

本文选题：三尖瓣下移畸形 + Ebstein畸形　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨改良锥形重建法三尖瓣下移畸形矫治术近中期临床效果。方法:回顾性分析山西医科大学第二医院2008年5月到2015年8月收治的18例三尖瓣下移畸形患者临床资料,所有患者均由超声心动图确诊,术前心电图检查8例示右束支传导阻滞;其中男8例,女10例,年龄5—41岁,平均年龄20.3±12.7岁。按NYHA心功能分级,心功能II级12例,III级6例,合并继发性房间隔缺损反常栓塞致左下肢急性动脉栓塞、坏疽致截肢1例,术后因三尖瓣关闭不佳,联合双孔技术1例。所有患者术前均给予强心、利尿、扩血管药物治疗,均采用改良锥形重建法矫治三尖瓣下移畸形,形成瓣叶间完全对合及中心性血流。对于前瓣叶发育不佳及较小者,运用自体心包加宽瓣叶。所有患者均用自体心包行瓣环加固。结果:术后2例发生心律失常,经药物治疗均恢复正常,余患者术后均恢复顺利,无死亡发生。复查超声心动图:1例三尖瓣中量返流,余17例患者瓣叶对合均较良好。术后随访9—38个月,心功能I级14例,心功能II级4例。结论:改良锥形重建法三尖瓣下移畸形矫治术近中期临床效果肯定,尤其18岁以下年轻人,弥补了之前其他术式随着病人身体的长大所带来的缺点及不足,可形成瓣叶的完全对合和中心性血流,更接近于心脏本身的解剖结构,抗返流能力强,减少二次手术及瓣膜置换的发生,降低术后死亡率,是目前比较理想的手术方式。
[Abstract]:Objective: to investigate the clinical effect of modified conical reconstruction method for correction of tricuspid valve deformity. Methods: the clinical data of 18 patients with tricuspid valve deformity treated in the second Hospital of Shanxi Medical University from May 2008 to August 2015 were retrospectively analyzed. All the patients were diagnosed by echocardiography. Preoperative electrocardiogram showed right bundle branch block in 8 cases, male 8 cases, female 10 cases, age 5-41 years, mean age 20.3 卤12.7 years. According to NYHA's classification of cardiac function, 12 cases of cardiac function grade II were grade III, 6 cases were complicated with abnormal embolization of secondary atrial septal defect, 1 case was amputation of left lower extremity, 1 case was amputation due to gangrene, and 1 case was combined with double hole technique because of poor tricuspid valve closure. All the patients were treated with cardiac strengthening, diuretic and vasodilator before operation. The modified conical reconstruction method was used to correct the tricuspid valve deformity, resulting in complete interlobar intervalvular involution and central blood flow. Autologous pericardial broadleaf was used for the patients with poor or small anterior lobe. All patients were treated with autologous pericardial annulus reinforcement. Results: arrhythmia occurred in 2 cases after operation and recovered to normal after drug therapy. All the remaining patients recovered smoothly and no death occurred. One case of tricuspid valve regurgitation was examined by echocardiography. Follow-up for 9-38 months showed that 14 patients had cardiac function grade I and 4 had cardiac function grade II. Conclusion: the clinical effect of modified conical reconstruction method for tricuspid valve deformity in the near to middle period is positive, especially for young people under 18 years old, which makes up for the shortcomings and deficiencies brought by other surgical methods with the patient's body growing up. It can form the complete involution and central blood flow of the valve lobe, which is closer to the anatomical structure of the heart itself, has strong anti-reflux ability, reduces the occurrence of secondary operation and valve replacement, and reduces the postoperative mortality. It is an ideal surgical method at present.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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