摘要
目的分析不同手术方法治疗三尖瓣下移畸形(Ebstein畸形)的临床效果,探讨各种手术方式的手术方法和近中期的治疗效果。方法回顾性分析我院2008年1月至2017年12月收治的24例Ebstein畸形患者的临床资料。根据不同的手术方法将患者分为三组:Carpentier法修复三尖瓣9例(Carpentier组)、锥形重建技术修复三尖瓣11例(Cone组)和全腔静脉肺动脉吻合4例(Fontan组)。所有患者均同时行纵向房化右心室折叠术及其他畸形矫治。记录三组患者术前、术后及1年后的血氧饱和度、心功能分级[纽约心脏病协会心脏功能分级(New York Heart Association,NYHA)]和三尖瓣反流程度。结果所有患者术后恢复顺利,随访期间无死亡病例。中期复查超声心动图提示,Carpentier组轻度三尖瓣反流3例,中度反流5例,重度反流1例。Cone组轻度三尖瓣反流10例,中度反流1例,无重度反流。所有患者术后心功能分级及血氧饱和度均有明显改善。结论Carpentier法、Cone法和Fontan法矫治Ebstein畸形均能改善患者心功能,提高血氧饱和度。Cone法修复三尖瓣中期效果更具优势。不具备双心室矫治条件的Ebstein畸形患者,行全腔-肺动脉吻合术,也能明显改善患者的心功能,提高生活质量。
Objective To explore the clinical effect of different surgical methods in the treatment of Ebstein's anomaly.Methods The clinical data of 24 patients with Ebstein malformation admitted from January 2008 to December 2017 in our hospital were reviewed.According to different surgical methods,the patients were divided into three groups:9 cases(Carpentier group)repaired by Carpentier method,11 cases(Cone group)repaired by conical reconstruction technique and 4 cases of total vena cava pulmonary artery anastomosis(Fontan group).All patients were treated with longitudinal atrial right ventricular folding and other defonnities treated at the same time.The oxygen saturation.cardiac function(New York Heart Association,NYHA)and tricuspid valve reflux degree of the three groups of patients were recorded before and after the operation and 1 year later.Results All patients recovered smoothly after surgery and no deaths was reported during follow-up.The mid-temi review echocardiography suggested that the Carpentier group had mild tricuspid valve reflux in 3 cases,moderate reflux in 5 cases and severe reflux in 1 case.There were 10 cases of mild tricuspid valve reflux,1 case of moderate reflux and no severe reflux in Cone group.The grade of cardiac function and the saturation of blood oxygen were improved obviously in all patients.Conclusion All the carpentier method,Cone method and Fontan method can improve the cardiac function and raise the blood oxygen saturated degree.The Cone method has an advantage more for metaphase.The Fontan method for the patients with Ebstein's anomaly who do not have the condition of double ventricular correction,can also obviously improve the cardiac function and improve the quality of life.
作者
朱伯卫
陈凯明
赖锋华
刘浪
ZHU Bo-wei;CHEN Kai-ming;LAI Feng-hua;LIU Lang(Department of Cardiovascular Surgery,Gaozhou People's Hospital,Gaozhou 525200,China)
出处
《中国心血管病研究》
CAS
2019年第5期451-454,共4页
Chinese Journal of Cardiovascular Research
