风湿性三尖瓣重度关闭不全外科治疗的疗效分析

The curative effect of surgical treatment for patients with severe rheumatic tricuspid valve regurgitation

目的评价三尖瓣成形术和三尖瓣生物瓣置换术对治疗风湿性心脏瓣膜病三尖瓣重度关闭不全的临床疗效。方法回顾性分析我院2014年1月至2016年12月37例风湿性心瓣膜病三尖瓣重度关闭不全患者的临床资料。按不同手术方式将患者分为两组：三尖瓣成形术组（成形组）23例和三尖瓣生物瓣置换术组（置换组）14例。术前两组患者的年龄、性别、心功能分级（NYHA）和三尖瓣反流分级等指标未见统计学差异（P〉0．05）。记录两组患者术前、术后及1年后随访的心功能分级、右心房横径、右心室舒张期末内径和三尖瓣反流面积。结果术后早期死亡3例（均为置换组），其中低心排2例、心律失常1例；其余患者均痊愈出院。中期随访各组生存率分别为：成形组23／23（100％）、置换组11／14（78．57％）；心功能分级分别为：成形组心功能I级13例、Ⅱ级6例、Ⅲ级4例，置换组心功能Ⅱ级7例、Ⅲ级3例、Ⅳ级l例。中期随访各组生存率、心功能分级差异有统计学意义（P〈0．05），成形组均优于置换组。中期随访三尖瓣反流分级分别为：成形组轻反流22例，中度反流1例，置换组轻度反流11例，比较未见统计学差异（P〉0．05）。结论三尖瓣生物瓣置换术后早期死亡率较高，患者心功能较差；三尖瓣成形术后中期反流程度与三尖瓣生物瓣置换术组相似，并且患者术后心功能良好、生存率较高，值得临床推广。

Objective To evaluate the clinical effect of tricuspid plasty and tricuspid biological flap re- placement on the treatment of tricuspid severe regurgitation in patients with rheumatic valvular heart disease. Methods he clinical data of 37 patients with tricuspid severe regurgitation have received tricuspid valvuloplasty or tricuspid biological flap replacement in our hospital was analyzed retrospectively. The patients were divided into two groups： Tricuspid plasty Group（forming group） 23 cases, tricuspid biological flap replacement Group（displace- ment group） 14 cases. There was no statistically significant difference in age, .sex, heart function grading（NYHA ） and tricuspid reflux grading in the two groups before operation（P〉0.05 ）. The cardiac function grading, right atrium transverse diameter, right ventricular diastolic end diameter and tricuspid reflux area were recorded before, after and after 1 years. Results Early postoperative death in 3 cases（all were plasty group, among them, 2 cases died of low cardiac discharge, arrhythmia in 1 case）. The remaining two groups were cured and discharged. The survival rates for the mid-term follow-up were： the forming group was 23/23 （100%）, displacement group 11/14 （78.57%）, and cardiac function grade were： Forming group heart function I Grade 13 cases, 11 grade 6 cases, III grade 4 cases, displacement group heart function II Grade 7 cases, III Grade 3 cases, IV Grade 1 case. There were statistically significant differences in survival rate and cardiac functional grading in all groups during the mid-term follow-up（P〈0.05）, and the forming group was superior to the displacement group. During the mid- term follow-up, tricuspid reflux were Forming group 22 cases of mild reflux, moderate reflux in 1 case, displace- ment group mild reflux in 11 cases, with no statistically significant difference（P〉0.05）. Conclusion Tricuspid bi- ological flap replacement has higher early mortality and less postoperative cardiac function, and the degree of reflux after tricuspid plasty is similar to that of tricuspid replacement, and the postoperative cardiac function is good and survival rate is high, which is worthy of clinical popularization.