全胸腔镜人工腱索二尖瓣成形术在二尖瓣关闭不全中的应用价值

Application value of complete thoracoscopic mitral valvuloplasty with artifical chordae for patients with mitral valve insufficiency

目的探讨全胸腔镜人工腱索二尖瓣形成术在二尖瓣关闭不全中的应用价值。方法选取我科收治的二尖瓣关闭不全患者50例,根据手术方式将患者分为常规组(单独成形环,25例)和人工腱索组(成形环+人工腱索,25例)。记录2组患者手术情况,对比2组患者术前、出院前、术后1年心脏彩超测量结果,评价手术疗效,并采用Kaplan-Meier法分析2组患者生存率。结果2组患者术中主动脉阻断时间、体外循环时间及手术总时间比较差异均无统计学意义(P>0.05)。2组患者出院前左房内径(LAD)、左室舒张期末内径(LVEDD)、左心室射血分数(LVEF)、右心室内径(RV)、右心房内径(RA)、二尖瓣反流面积(MRA)及术后12个月LAD、LVEDD、RV、RA、MRA与术前比较,差异具有统计学意义(P<0.05)。组间比较结果显示,2组患者术前LAD、LVEDD、左室收缩期末内径(LVESD)、LVEF、RV、RA及MRA比较,差异无统计学意义(P>0.05);2组患者出院前和术后12个月LAD、LVEDD、LVESD组间比较,差异无统计学意义(P>0.05);人工腱索组患者出院前和术后12个月LVEF均高于常规组,而术后12个月RV、RA、MRA均低于常规组(P<0.05)。超声心动图检测结果显示,2组患者术后12个月二尖瓣反流程度比较,差异无统计学意义(P>0.05)。疗效分析及Kaplan-Meier生存分析结果显示,人工腱索组患者治疗总有效率及术后12个月生存率高于常规组,差异具有统计学意义(P<0.05)。结论全胸腔镜下人工腱索二尖瓣成形术可有效改善二尖瓣关闭不全患者心功能,安全可靠,疗效确切。

Objective To evaluate the value of complete thoracoscopic mitral valvuloplasty with artifical chordae for patients with mitral valve insufficiency.Methods A total of 50 patients with mitral valve insufficiency in our department were selected.According to the surgical methods,these patients were divided into the conventional group(prosthetic ring,25 cases)and the artificial chordae group(prosthetic ring combined with artificial chordae implantation,25 cases).The surgical conditions of the two groups were recorded,and the results of cardiac ultrasound measurement before operation,before discharge and 1 year after operation were compared between the two groups to evaluate the surgical efficacy.The survival rate of patients in the two groups was analyzed by the Kaplan-Meier method.Results There was no significant difference in the intraoperative aortic occlusion time,extracorporeal circulation time or total operative time between the two groups(P>0.05).The left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),right ventricular diameter(RV),right atrial diameter(RA),mitral regurgitation area(MRA)before discharge and LAD,LVEDD,RV,RA,MRA in 12 months after operation of the two groups were compared with those before operation,and the differences were statistically significant(P<0.05).The comparison between the two groups showed that there was no statistical significance in the preoperative LAD,LVEDD,left ventricular end systolic diameter(LVESD),LVEF,RV,RA or MRA between the two groups(P>0.05).There was no significant difference in LAD,LVEDD or LVESD between the two groups before discharge and 12 months after operation(P>0.05).LVEF before discharge and 12 months after operation in the artificial chordae group was higher than that in the conventional group,while RV,RA and MRA 12 months after operation were lower than those in the conventional group(P<0.05).The results of echocardiography showed that there was no statistical significance in the degree of mitral regurgitation between the two groups 12 months after surgery(P>0.05).Results of efficacy analysis and Kaplan-Meier survival analysis showed that the total effective rate and 12-month survival rate of patients in the artificial chordae group were significantly higher than those in the conventional group,with statistical difference(P<0.05).Conclusion Complete thoracoscopic mitral valvuloplasty with artifical chordae implantation can effectively improve the cardiac function of patients with mitral valve insufficiency,which is safe and reliable with definite efficacy.