三尖瓣成形术与置换术治疗中重度三尖瓣关闭不全的效果分析
发布时间：2018-09-04 13:49
【摘要】：目的比较三尖瓣成形术及三尖瓣置换术治疗中重度三尖瓣关闭不全的术后早期及中期生存率和并发症率,评价三尖瓣成形术与三尖瓣置换术治疗中重度三尖瓣关闭不全的效果,为此类手术提供借鉴。方法回顾性分析2003年1月至2008年6月在我院住院治疗的合并左心瓣膜疾病或者先天性心脏病的三尖瓣关闭不全患者,部分患者有双下肢水肿、颈静脉充盈、肝肿大等右心衰症状,给予改善心功能治疗后行三尖瓣手术的患者228例,其中127例患者行三尖瓣成形术,101例患者行三尖瓣置换术。收集围手术期资料,并随访65个月,评价两种手术方法治疗合并右心衰竭的中重度三尖瓣关闭不全的效果。结果三尖瓣成形组,男性51例,女76例,平均年龄(57.97±9.24)岁,三尖瓣置换组,男性52例,女49例,平均年龄(57.87±9.35)岁。三尖瓣成形组术前三尖瓣中度反流68例,重度反流49例,三尖瓣置换组中度和重度反流分别为41例、60例。三尖瓣成形组术前心功能II级22例(17.3%)、III级79例(62.2%)、IV级26例(20.5%),三尖瓣置换组心功能II级、III级、IV级分别为11例(10.9%)、56例(55.4%)、34例(33.7%)。三尖瓣成形组术前肝功能异常率(4.4%)低于三尖瓣置换组(10.9%)(P=0.023),三尖瓣成形组术前平均肺动脉收缩压(53.48±14.32)mmHg低于三尖瓣置换组(57.62±14.65)mmHg(P=0.033),余术前资料差异无统计学意义(P值均0.05);三尖瓣置换组患者平均主动脉阻断时间、体外循环时间、呼吸机辅助时间及ICU停留时间、正性肌力药物使用量明显高于三尖瓣成形组患者,且有显著性差异(P0.01);术后早期两组患者在右心房右心室内径、左室射血分数及肺动脉收缩压差异无统计学意义(P值均0.05),三尖瓣成形组术后早期并发症例数20例,并发症率为(15.75%)低于三尖瓣置换组并发症例数27例,并发症率(27.27%)(P=0.042);,三尖瓣成形组围手术期死亡例数8例,死亡率(6.3%)低于三尖瓣置换组死亡17例,死亡率(16.83%)(P=0.011)。长期随访发现三尖瓣成形组三尖瓣中重度反流复发33例(28.7%)高于三尖瓣置换组7例(8.75%)(P=0.011);三尖瓣成形组心功能I级18例、II级88例、III级9例,三尖瓣置换组心功能I级、II级、III级分别为11例、59例、10例,差异无统计学意义(P值分别为0.713,0.659,0.279);三尖瓣成形组患者术后3月、1年、3年、5年生存率高于三尖瓣置换组,但差异无统计学意义(P分别为0.231,0.089,0.133,0.078)。结论在合并中重度三尖瓣关闭不全患者治疗中,三尖瓣成形术早期治疗效果优于三尖瓣置换术;三尖瓣成形术后中期三尖瓣中重度反流复发率高于三尖瓣置换术。
[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 卤9.24) years old. There were 52 males and 49 females with mean age of (57.87 卤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 卤14.32) mmHg lower than that in tricuspid valve replacement group (57.62 卤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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
本文编号：2222286
[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 卤9.24) years old. There were 52 males and 49 females with mean age of (57.87 卤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 卤14.32) mmHg lower than that in tricuspid valve replacement group (57.62 卤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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
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