两种三尖瓣成形术治疗功能性三尖瓣返流疗效比较

Efficacy comparison of two methods of tricuspid annuloplasty in the treatment of functional tricus- pid regurgitation

目的探讨在瓣膜置换术同期行三尖瓣成形术的合理手术指征、方法及围术期的处理。方法回顾性分析2005年12月至2009年1月间行三尖瓣成形术治疗中度至重度功能性三尖瓣关闭不全126例患者的临床资料，其中行Devega成形61例，人工环成形65例。同时行二尖瓣置换84例，二尖瓣＋主动脉瓣置换42例。结果术后早期死亡4例，死于顽固性心力衰竭，病死率为3．2％，以术后第2年随访结果做为对比分析观测点，获访114例，心功能明显改善。心脏超声示右心房及右心室较术前明显缩小。共有20例仍有申度以上返流。结论在瓣膜置换术中据三尖瓣环扩大的部位及返流程度使用三尖瓣成形环进行三尖瓣成形具有更良好的中期疗效，围术期及术后加强强心、利尿及扩血管治疗有效降低肺动脉高压，可进一步提高三尖瓣成形近、远期疗效。

Objective To investigate the operation indications, surgical procedures and peri -operative management of functional tricuspid insufficiency （FH） secondary to rheumatic valve disease. Methods Tricuspid annuloplasty was performed in 126 patients from Dee 2005 to Jan 2009 with rheumatic valve disease and FTI. They were divided into devegar procedure group （ n = 61 ）, and ring annuloplasty group （ n = 65 ）. All patients underwent in addition one - stage valve replacement including mitral valve replacement in 84 cases and combined aortic and mitral valve replacement in 42 cases. Results Early mortality was 4 cases （3. 2% ）. Follow - up was made in 114 patients for 2 years. Four patients died of cardiac failure, and the others were considerably improved in quality of life. Diameter of right atriums and ventri- cles was significantly shorter than that preoperatively. Mild to moderate tricuspid insufficiency remained in 20 cases. Conclusions According to location of tricuspid annulus dilatation and degree of FTI, Ring an- nuloplasty was an effective treatment for functional tricuspid regurgitation with better midterm result. Diuretics and vasodilators are helpful to reduce pulmonary artery hypertension and improve longterm effect.