摘要
目的:探讨二尖瓣成形术在儿童二尖瓣关闭不全的治疗效果。方法:回顾性研究2008年7月1日至2018年7月1日于重庆医科大学附属儿童医院行二尖瓣成形术的135名患儿临床资料,其中男55名,女80名。手术方式包括二尖瓣交界成形术(90例)、瓣环环缩成形(13例)、裂缺缝合(29例)、双孔二尖瓣(20例)、腱索缩短术(5例)、三角切除术(5例)。若合并其他心内畸形,则一并矫正。采用配对t检验对比术前及术后超声心动图中反流程度、左房内径(left atrial diameter,LAD)、左室舒张期末内径(left ventricular end-diastolic diameter,LVDd)、左室收缩期末内径(left ventricular end-systolic diameter,LVDs)和左室射血分数(left ventricular ejection fraction,LVEF)等来评估手术效果。结果:135名患儿均顺利完成手术,术中无死亡病例。院内死亡率为5.2%,二次手术率为2.3%,剩余125名患儿门诊随访,失访率为8.8%,平均随访时间(18.2±15.2)个月。患儿术后平均LAD[(20.0±5.8)mm]、LVDd[(33.7±6.3)mm]、LVDs[(21.6±4.9)mm]较术前明显减小(P=0.000),LVEF[(68.7±4.6)%]较术前提高(P=0.000),差异有统计学意义。术后82.5%的患儿反流程度降至中度或以下。结论:二尖瓣成形术在儿童二尖瓣关闭不全的治疗中手术效果确切,并发症少,可作为首选术式。若合并其他心内畸形,可同期矫治,效果良好。
Objective:To investigate the effect of mitral valvuloplasty in the treatment of children with mitral insufficiency. Methods:A retrospective analysis was performed on the clinical data of 135 children(55 males and 80 females)who had undergone a mitral valvuloplasty in Children’s Hospital of Chongqing Medical University from July 1,2008 to July 1,2018. The surgical approaches included mitral commissurotomy(90 cases),annuloplasty(13 cases),cleft suture(29 cases),double-orifice valve repair(20 cases),shortening of chordae tendineae(5 cases),and triangular resection(5 cases). Concomitant intracardiac anomalies were treated simultaneously if present. The paired t-test was used to evaluate the effect of the operation by comparing the following preoperative and postoperative results:degree of regurgitation,left atrial diameter(LAD),left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs),and left ventricular ejection fraction(LVEF). Results:All of the 135 children had a successful operation,and no death occurred during the operation. The in-hospital mortality rate was 5.2%,and the reoperation rate was 2.3%;125 children remained in the clinic follow-up,with a loss to follow-up rate of 8.8%;the mean follow-up duration was(18.2±15.2)months. After the operation,there were signifi cant reductions in the mean values of LAD,LVDd,and LVDs[(20.0±5.8)mm,(33.7±6.3)mm,and(21.6±4.9)mm,respectively,P=0.000],and a significant increase in LVEF[(68.7±4.6)%,P=0.000];82.5% of the children had their regurgitation reduced to a moderate or lower degree. Conclusion:Mitral valvuloplasty has a definitive effect in the treatment of children with mitral insufficiency with few complications observed,which makes it the optimal surgical approach for the disease;other concomitant intracardiac anomalies can be simultaneously treated if present,with a good outcome to be expected.
作者
栾果
安永
吴春
普金海
Luan Guo;An Yong;Wu Chun;Pu Jinhai(Department of Cardiothoracic Surgery,Children’s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2020年第4期454-458,共5页
Journal of Chongqing Medical University
基金
国家自然科学基金面上资助项目(编号:NSFC 81370432)
重庆市科委基金资助项目(编号:cstc2016jcyjA0827)
重庆市教委科学基金资助项目(编号:KJ1500237)
重庆市科卫联合医学科研资助项目(中青年高端医学人才项目)(编号:2018GDRC005)
重庆医科大学儿科学院教学研究资助项目(一类项目)。
