三尖瓣适当切开修补室间隔缺损的近中期随访研究

Short-and Mid-term Follow-up Study on Tricuspid Valve Detachment in Correction of Ventricular Septal Defect

目的探讨三尖瓣适当切开技术(tricuspid valve detachment,TVD)在室间隔缺损(ventric-ular septal defect,VSD)修补手术中的临床价值。方法回顾性分析我院2006年1月～2010年12月行VSD修补的1 021例患者的临床资料,其中211例采用TVD技术(TVD组),810例未采用TVD技术(非TVD组)。所有患者在术前与术后3 d、1个月、6个月及1年行超声心动图观察心脏结构,评估三尖瓣返流(tricuspic regurgitation,TR)情况。结果 695例补片修补VSD,其中TVD组209例(128例使用单独缝线修补瓣叶切口,81例使用VSD补片缝线),非TVD组486例;另326例直接缝合VSD,其中TVD组2例(使用VSD补片缝线直接修补瓣叶切口),非TVD组324例。671例进行了合并畸形手术,其中TVD组115例(占TVD组54.5%),非TVD组556例(占非TVD组68.6%)。两组CPB时间、主动脉阻断时间及术后住院时间比较,均无统计学差异(P>0.05)。两组均无围手术期死亡病例。TVD组无完全性房室传导阻滞出现,非TVD组出现3例,均于术后10 d内恢复窦性。术后3 d VSD残余漏11例,其中TVD组3例,非TVD组8例;TVD组轻度以上的TR病例14例,非TVD组有47例。两组均无因TR和残余漏而再手术者。两组术后并发症发生率比较无统计学差异(8.1%VS 7.2%,P>0.05)。所有病人随访1年,无远期死亡病例,均无残余漏需远期再手术者。术后1年TVD组无轻度以上TR,非TVD组有8例轻度以上TR,组间比较差异无统计学意义(P>0.05)。两组均无因TR再手术者。结论 TVD是一种安全、有效的技术,能改善VSD的暴露,与传导阻滞、手术时间延长以及TR无相关性。TVD能保护三尖瓣瓣叶结构,减少术后严重TR的发生。

Objective To investigate the clinical value of temporary tricuspid valve detachment （TVD） in the correlation of ventricular septal defect （VSD）. Methods A total of 1 021 VSD patients admitted January 2006 to December 2010 in our hospital were analyzed retrospectively, including 211 of TVD （TVD group） and 810 of non-TVD （non-TVD group）. All patients were observed cardiac structure and assessed tricuspid regurgita- tion（TR） by echocardiography in preoperative and three days, a month, 6-month and I-year postoperative. Re- sults 695 cases were repaired with patch, including 209 of TVD group and 486 of non-TVD group. Another 326 cases were repaired by suturing VSD directly, including 2 of TVD group and 324 of non-TVD group. There was no statistic difference in cardiopulmonary bypass time, aorta blocking time and postoperative hospital stay between two groups （P 〉 0.05）. There was no peroperative death in both two groups. Complete atrioventricular block was 0 and 3, residual leak was 3 and 8, and tricuspid regurgitation was 14 and 47 in TVD group and non-TVD group respectively. There was no statistic difference in postoperative complication rate between two groups （8.1% VS 7.2%, P 〉 0.05）. All cases were followed up for one year without long-term death and reoperation associated with residual leakage. No case was found mild TR in TVD group, and 8 cases in non-TVD group, there was nostatistic difference between two groups （P 〉 0.05）. Conclusion TVD is a safe and effective technique for im- proving the VSD exposure, has no correlation with the atrioventricular block, surgical time and TR, and can pro- tect the tricuspid valve leaflets structure and reduce the incidence of serious postoperative TR.