目的:探讨二尖瓣成形术治疗二尖瓣返流的临床疗效.方法:回顾性分析2012年1月至2016年12月在我院心血管病院心脏大血管外科行二尖瓣成形术的非风湿性、缺血性、合并大血管疾病的72例患者的临床资料,其中男45例(62.5 %),女27例(37.5 %);年龄19~69(48.81 ± 12.60)岁.单纯二尖瓣病变63例(后瓣病变51例,前瓣病变12例,含腱索断裂3例),合并先天性心脏病8例(房间隔缺损6例,室间隔缺损2例),左房粘液瘤1例.术前均经彩色超声心动图检查诊断:二尖瓣中度关闭不全28例,重度44例,平均返流量(14.93 ± 8.22)ml.结果:术中经注水实验或食管超声心动图评价成形效果满意,术后早期无死亡.随访6~71个月(41.53 ± 13.32)月,随访72例,随访率100 %;硬膜下出血1例,无溶血、肾功能衰竭等并发症,随访患者心功能分级(NYHA)Ⅰ级48例,Ⅱ级21例,Ⅲ级3例.超声心动图提示:术后LAD[(47.03 ± 9.36)mm与(54.69 ± 11.73)m m,t=6.297,P<0.05],LVEDD[(49.08 ± 4.93)m m与(53.97 ± 7.00)m m, t=4.759,P<0.05]与术前比较明显缩小,差异有统计学意义(P<0.05);LVEF 与术前比较也有明显变化[(61.33 ± 5.21)% 与(58.94 ± 6.32)%,t= -2.413,P<0.05].无或微量返流55例(76.4%),轻度返流15例(20.8%),重度返流2例(2.8%,1例二尖瓣A1、A2区撕脱,1例二尖瓣人工腱索乳头肌撕脱,均行二次换瓣手术),再手术率2.8%.未发现明显二尖瓣狭窄.全组无死亡病例.结论:虽然二尖瓣成形手术相对复杂,但根据患者的具体情况及术者经验,选择相应的成形方法可取得满意的临床效果.%Objective:To summarize the experiences and analyze the efficacy of mitral valvuloplasty in treating mitral regurgitation.Methods:A total of 72 consecutive non-rheumatic,non-ischemic and not associated with aortic disease mitral regurgitation patients were in,including 45 males and 27 females who underwent the operation of mi-tral valvuloplasty from January 2012 to December 2016 were analyzed re trospectively.The age of these patients ranged from 19 to 69 years old(48.81 ± 12.60)years.There were 63 cases of mitral valve regurgitation(51 cases of posterior valve lesions,12 cases of anterior valve lesions and these patients contain 3 cases with chordae rupture)and 8 cases combine with Congenital heart disease(6 ASD,2 VSD),and 1 cases combine with left atrial myxoma.Mitral regurgitation were diagnosed by color Doppler echocardiography:with moderate in 28 and severe in 44,Mean mitral regurgitation(14.93 ± 8.22)ml.Results During the operation,transesophageal echocardiography and saline injection test showed satisfying results in all the patients.No early death occurred after operation.Follow-up was done to 72 patients for 3 months to 71 months with a follow-up rate of 100%.Subdural hemorrhage occurred in 1 cases,No he-molysis,renal failure and other complications.During the follow up,48 patients were in New Yoke Heart Associatio n(NYHA)class Ⅰ,21 in Cla ss Ⅱ,3 in class Ⅲ.The Echocardiography showed that postoperative left atrium diame-ter[(47.03 ± 9.36)mm vs(54.69 ± 11.73)mm,t=6.297,P<0.05]and left ventricular end-diastolic dimension [(49.08 ± 4.93)mm vs(53.97 ± 7.00)mm,t=4.759,P<0.05]were significantly smaller than that before opera-tion.Compared with preoperative LVEF,there were also statistical significance[(61.33 ± 5.21)% vs(58.94 ± 6. 32)%,t= -2.413,P<0.05].No or trace mitral regurgitation(MR)was found in 55 patients(76.4%),mild MR in 15 patients(20.8%),and severe M R in 2 patients(2.8%,Avulsion of A1 and A2 in 1 cases of mitral valve,Avulsion of the artificial Chordae papillary muscle of mitral valve in 1 cases,they all underwent valve replacement again),Reo-peration rate 2.8%.There were no mitral stenosis and died during the follow up.Conclusion:Although mitral valvu-loplasty is complicated,according to the patient's specific conditions and the experience of the operator,the choice of the corresponding forming method can achieve satisfactory clinical results.
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