论文标题:双孔成形术治疗二尖瓣关闭不全的早中期疗效评价
Early and Midterm Results of Double-orifice Technique for Mitral Regurgitation
论文作者 齐贺文
论文导师 张秀和,论文学位 硕士,论文专业 外科学
论文单位 吉林大学,点击次数 137,论文页数 58页File Size525k
2005-04-10论文网 http://www.lw23.com/lunwen_58367962/ 二尖瓣关闭不全;双孔成形术
mitral regurgitation ; double-orifice technique
本研究的目的:进一步探讨双孔成形术治疗二尖瓣关闭不全的临床效果。方法:对7 例二尖瓣关闭不全病人进行双孔成形术,并在术前、术中和术后利用超声心动图进行评价。结果:术后5 例无瓣膜返流,2 例轻度返流。全组无术后死亡。随访5 至29 个月,失访1 例,余所有病人心功能(NYHA)为I 级;超声心动图显示双孔成形术后瓣膜活动良好,无瓣口狭窄。应用配对t 检验,对患者术后1 周、随访的心彩超与患者术前心彩超参数进行比较,P<0.05,有统计学意义。表1 显示超声心动图观察双孔成形术的成形效果。结论:双孔成形术操作相对简单,容易掌握,并有良好的早、中期临床效果,其远期疗效有待进一步探讨。
Background: Mitral regurgitation is that the two pieces of mitral valve couldn’t be closed in systolic period because the change of mitral structure involved in all kinds of diseases. The pathogenesis of mitral regurgitation consists of rheumatic disease, ischemic disease, congenital disease, infectious disease, degenerative disease and inherited disease etc. The surgical therapy style include mitral repair and mitral replacement with prostheses valve .Mitral replace procedure has been maturated and there is no mitral regurgitation after the procedure. But they need to take anticoagulation medicine for the patients accepted mitral replacement procedure .So there are some inevitable complications of anticoagulation medicine. For example, there is hemorrhage of all kinds of the tissue and organs in the whole body for the excessive dosage of anticoagulation medicine and embolism of all kinds of the tissue and organs in the whole body for the shortage dosage of anticoagulation medicine. There also consist of valve blocked, the leak of valve circumference, infectious endocarditis, hemolysis and the rupture of left ventricle. Mitral repair procedure rose lately and there were more procedures, but the post-operation effect couldn’t confirmed. But also the post-operation effect is deeply correlated with the technique of operator .Mitral repair procedure not only has the lower embolism, no complications of anticoagulation and protecting the modality and function of left ventricle ,but also the patients could acquire better post-operation living quality. Especially, it adapt to the children because their heart are no maturity and the mitral valve annulus is very small. If we replace the smaller prostheses valve with the mitral valve ,the graft couldn’t be adapted to the need of the children upgrowth .So we must replace the valve at second time. But the mitral repair procedure are not stable and need to reoperation. The basic requirements of mitral valve repair procedure is that reserving sufficient area of anterior leaflet of mitralvalve ,better activity of anterior leaflet of mitral valve and adequate veil interface area between anterior leaflet and posterior leaflet .Basing on the different parts and all kinds disease, the mitral repair technique consists of leaflet repair, chordal repair, annuloplasty and double-orifice technique ect. Alfieri applied the double-orifice technique to cure the mitral regurgitation at first in 1995.The technique is that they suture the midpoint of anterior and posterior leaflets together and format two hole in the mitral valve. It not only satisfied with the basic requirements of mitral valve repair procedure but also broke the traditional “single hole”definition in valve repair procedure. It simplified the surgery procedure and reserved useful tendon and papillary muscle. The key of the procedure is to search the point of regurgitation. The point of mitral regurgitation was not usually the midpoint of two leaflets because of the prolapse of anterior leaflet or posterior leaflet .So we must observe the regurgitation by affusion test again and again and adjust the fixup point .Therefore the area of two holes wasuncertainly symmetrical. Some research showed that the velocity of flow and pressure gradient were same with the physiology although the area of two holes was unsymmetrical. The velocity of flow and pressure gradient were unaffected with the size of the two holes under postoperation. So the double-orifice technique couldn’t affect on the dynamics of blood streams. The double-orifice technique could resume the veil interface of anterior leaflet and posterior leaflet at closing .It could increase the veil interface to shrink the mitral annulus at the same time .Therefore we recommend applying the double-orifice technique with annuloplasty. But we must notice the relation between the degree of shrinking annulus and the hatch area of mitral valve. It is import to adjust the degree of shrinking annulus on the fact. Otherwise, only repairing the dilated annulus in the process of annulop
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