保留全部或部分二尖瓣结构的二尖瓣置换术的临床研究

Clinical study on mitral valve replacement with partial or entire preservation of subvalvular apparatus.

目的 比较全部保留和部分保留瓣下结构的二尖瓣置换术的近、远期疗效。方法 随机选取 4 4例接受二尖瓣置换术的患者 ,随机分为两组 ,A组接受全部保留瓣下结构的二尖瓣置换术 ,B组接受部分保留瓣下结构的手术 ,比较两组在术后早期的血流动力学变化和术后 3个月及 6个月的超声心动图改变。结果 A组与B组在术后早期血流动力学指标以及术后呼吸机应用时间、重症监护时间上均无显著性差异 ,术后 3个月两组的超声心动图指标均无明显差异 ,术后 6个月A组左室长轴收缩末纵径与B组比较有显著性差异。结论 同等条件下应首选全部保留瓣下结构的二尖瓣置换术 ,但不必强求全瓣结构保留 。

Objective To compare the short- or long-term curative effect after mitral valve replacement with partial or entire preservation of subvalvular apparatus.Methods All 44 patients were randomly divided two groups. Group A: Mitral valve replacement with entire preservation of subvalvular apparatus; Group B: Mitral valve replacement with partial preservation of subvalvular apparatus. Parameters of hemodynamics and echocardiogram were measured in early postoperative period and late postoperative period (3 and 6 months after operation).Results Two groups had no significant difference in parameters at early postoperative period, and in echocardiogram at 3rd month after surgery. At 6th month after operation, there was significant difference in LVESL.Conclusion Mitral valve replacement with entire preservation of subvalvular apparatus is the first choice in mitral valve operation. The concrete manner of operation, however, depends on pathological changes of valve and surgeon's experience.