改良Morrow手术治疗肥厚型梗阻性心肌病的疗效分析

Clinical Outcomes of Modified Morrow Procedure for the Treatment of Hypertrophic Obstructive Cardiomyopathy

目的比较采用经典Morow术与改良Morrow术治疗肥厚型梗阻性心肌病的疗效。方法选取2005年1月至2011年7月在北京安贞医院接受手术治疗的42例肥厚型梗阻性心肌病患者。根据手术方式不同将患者分为两组。传统Morrow组16例，男13例、女3例，年龄（49±15）岁；改良Morrow组26例，男14例、女12例，年龄（40±18）岁。改良Morrow术是在经典Morrow手术的基础上，扩大室间隔的切除范围，切除范围由经典的2～3cm扩大达到5～6cm，向下切除范围由经典的单纯室间隔基底部扩大到心尖部；同时根据二尖瓣的结构情况，进行二尖瓣乳头肌松解、二尖瓣前叶横向折叠成形、“缘对缘”二尖瓣成形或瓣膜置换。术前术后均进行超声心动图检查，比较两组室间隔厚度、左心室流出道流速及左心室流出道压差的差异。结果肥厚型梗阻性心肌病患者通过经典Morrow术与改良Morrow术治疗后，室间隔厚度、左心室流出道流速及左心室流出道压差均较术前显著降低。经典Morrow术患者的室间隔厚度[（23．10±3．64）mm vs．（17．38±4．39）mm]、左心室流出道流速[（433．08±101．68）mm／s vs．（248．46±101．88）mm／s]、左心室流出道压差[（78．57±40．16）mmHg vs．（4．29±21．52）mmHg]术前和术后差异均有统计学意义（P〈0．05）。改良Morrow术患者的室间隔厚度[（25．04±7．05）mm vs．（18．38±6．55）mm，P〈0．05]、左心室流出道流速[（414．83±83．33）mm／s vs．（159．72±60．84）mm／s，P〈0．05]、左心室流出道压差[（77．94±29．16）mmHg vs．（17．56±9．39）mmHg，P〈0．05]术前和术后差异均有统计学意义（P〈0．05）。改良Morrow手术患者手术前后左心室流出道压差的变化程度较经典Morrow患者更明显[（74．25±27．91）mmHg vs．（34．63±30．66）mmHg，P〈0．05]。结论改良Morrow术可明显减低肥厚型梗阻性心肌病患者左心室流出道压差，效果优于经典Morrow术。

Objective To compare clinical outcomes between modified and traditional Morrow procedures for the treatment of hypertrophic obstructive cardiomyopathy （HOCM）. Methods Forty-two HOCM patients undergoing surgical correction in Beijing Anzhen Hospital between January 2005 and July 2011 were recruited in this study. According to different surgical techniques, all the patients were divided into 2 groups. In traditional Morrow procedure group, there were 16 patients including 13 males and 3 females with their age of 49 ＋ 15 years. In modified Morrow procedure group, there were 26 patients including 14 males and 12 females with their age of 40 ＋ 18 years. Preoperative and postoperative echocardiography were performed to compare ventricular septal thickness （VST）, left ventricular outflow tract velocity （LVOTV） and left ventricular outflow gradient （LVOG） between the 2 groups. Results VST, LVOTV and LVOG of HOCM patients were significantly reduced after both traditional and modified Morrow procedure. There was statistical difference in preoperative and postoperative VST （23.10±3.64 mm vs. 17.38±4.39 mm）, LVOTV （433.08±101.68 mm/s vs. 248.46±101.88 mm/s） and LVOG （78.57±40.16 mm Hg vs.4.29±21.52 mm Hg） in traditional Morrow procedure group （P 〈 0.05）. There was statistical difference in preoperative and postoperative VST （25.04±47.05 mm vs. 18.38± 6.55 mm, P 〈 0.05 ）, LVOTV （414.83±83.33 mm/s vs. 159.72±60.84 mm/s,P 〈 0.05） and LVOG （77.94±29.16 mm Hg vs. 17.56±9.39 mm Hg,P 〈 0.05） in modified Morrow procedure group （P 〈 0.05）. Preoperative and postoperative difference in LVOG of modified Morrow procedure group was more significant than that of traditional Morrow procedure group （74.25 ±27.91 mm Hg vs. 34.63 ±30.66 mm Hg,P 〈 0.05 ）. Conclusion Modified Morrow procedure is superior to traditional Morrow procedure in reducing postoperative LVOG for HOCM patients.