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110例部分房室管畸形的手术治疗经验

The clinical experience of surgical treatment for partial atrioventricular canal defect in 110 patients
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摘要 目的部分房室管畸形是一种较少见的复杂先天性心脏病。文中分析110例部分房室管畸形的手术治疗方法,为提高临床治疗效果提供借鉴。方法对110例部分房室管畸形的临床资料进行回顾性分析。对二尖瓣大瓣裂的处理,108例采用单纯瓣裂缝合,其中另行瓣环成形6例,加瓣叶、乳头肌或腱索成形各3例,机械瓣置换2例;原发孔房间隔缺损均以自体心包补片修补,57例采用Kirklin法、53例采用McGoon法;同时纠治三尖瓣关闭不全及其他合并畸形。结果术后早期死亡3例,病死率2.7%。发生Ⅲ度传导阻滞2例,Kirklin法、McGoon法各1例,组间比较差异无统计学意义(P〉0.05)。99例随访0.5~20年,无远期死亡,复查心脏超声二尖瓣关闭不全完全纠正70例,残留轻度关闭不全26例,仍有中度关闭不全3例,心功能均得到明显改善。结论早期手术矫治部分房室管畸形可取得满意疗效,合理的手术设计、尽可能消除二尖瓣返流及避免损伤传导组织是手术成功的关键。 Objective Partial atrioventricular canal defect is a rare and complex type of congenital heart disease.The present study retrospectively reviewed the experiences of surgical treatment for partial atrioventricular canal defect in 110 patients. Methods All of 110 patients with partial atrioventricular canal defect from April 1989 to April 2009 were analyzed retrospectively.The mitral valve insufficiency was rectified with direct suture on cleft of mitral valve in 108 cases and mitral valve replacement in 2 cases.The ostium primum atrial septal defect was repaired with Kirklin procedure in 57 cases and McGoon procedure in 53 cases respectively.The accompanying cardiac deformities were corrected at the same time.Results One patient died of heart failure,one of respiratory failure and one of low cardiac output syndrome,mortality was 2.7%.The incidence rate of complete atrioventricular block was 1.8%(1/57) in the group with Kirklin postoperative and 1.9%(1/53) in the group with McGoon′s procedure.There was no statistical significance between the 2 groups(P0.05).99 cases were followed up for 6 months to 20 years without late death.Postoperative cardiac furction was notably improved in all patients.The cardiac ultrasound examination revealed that the mitral insufficiency was fully rectified in 70 patients,26patients had mild mitral regurgitation,and 3 had midrange mitral regurgitation.Conclusion Early surgical management was definitely beneficial to partial atrioventricular canal defect.Reasonable operative design,eliminating regurgitation of mitral valve and avoiding damage to conducting bundles are the key points in improving therapeutic effect.
出处 《医学研究生学报》 CAS 2010年第11期1145-1147,共3页 Journal of Medical Postgraduates
基金 南京军区医药卫生重点项目(08Z027)
关键词 部分房室管畸形 原发孔房间隔缺损 二尖瓣关闭不全 完全性房室传导阻滞 外科手术 Partial atrioventricular canal defect Primum atrial septal defect Mitral valve insufficiency Complete atrioventricular block Surgical procedures
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参考文献13

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