保留瓣叶及瓣下结构二尖瓣置换术480例临床分析

Clinical analysis of 480 patients undergoing mitral valve replacement with preservation of mitral leaflet and subvalvular structures

目的探讨保留二尖瓣瓣叶及瓣下结构二尖瓣置换的临床经验和治疗效果。方法以2009年1月至2012年12月在我院行保留二尖瓣瓣叶及瓣下结构的480例二尖瓣置换患者为观察组,二尖瓣瓣叶全部切除二尖瓣置换的350例患者为对照组。统计分析两组患者术前、术后6个月和12个月的Tei指数、Z指数、左心室射血分数(LVEF)和右心室射血分数(RVEF)。结果观察组患者手术成功率为98.3%,术后6个月和12个月患者的Tei指数、Z指数、LVEF、RVEF逐渐好转,术后12个月各项指标测量值均优于术后6个月的测量值,差异有统计学意义(P<0.05)。Tei指数与Z指数、LVEF、RVEF负相关,Z指数、LVEF、RVEF两两正相关,且各指标相关性分析|r|<1且≠0具有统计学意义。术后6个月观察组患者的Tei指数、Z指数、LVEF、RVEF明显优于对照组,差异均有统计学意义(P<0.05)。结论保留二尖瓣瓣叶及瓣下结构二尖瓣置换术适用于大多数二尖瓣病变患者,对于术后左、右心功能的改善及远期生活质量的提高有重要的意义。

Objective To explore the clinical experience and therapeutic effect of mitral valve replacement with leaflet and subvalvular structures preserved. Methods Four hundred and eighty patients who underwent mitral valve replacement with leaflet and subvalvular structures preserved in our hospital from January 2009 to December 2012 were se-lected as observation group, and 350 patients undergoing total mitral valve replacement were enrolled as control group. Tei index, Z index, left ventricular ejection fraction （LVEF）, right ventricular ejection fraction （RVEF） were compared between the two groups preoperatively, 6 months and 12 months after surgery. Results The success rate of operation reached 98.3%. Tei index, Z index, LVEF and RVEF showed improvement 6 months and 12 months after surgery, and the indexes 12 months after surgery were significantly better than those 6 months after surgery （P〈0.05）. Tei index was found negative-ly correlated with Z index, LVEF and RVEF. There were positive correlations between Z index, LVEF and RVEF, with the correlation coefficient｜r｜〈1 and≠0. Tei index, Z index, LVEF and RVEF 6 months after surgery in the observation group were significantly better than those of the control group （P〈0.05）. Conclusion Mitral valve replacement with leaflets and subvalvular structures preserved can apply to most patients with mitral valve disease. It has important implications for pro-moting left and right heart function, as well as improving long-term life quality.