• 南京醫(yī)科大學(xué)第一附屬醫(yī)院 江蘇省人民醫(yī)院 胸心外科， 南京 210096;

目的 比較一種改良三尖瓣成形術(shù)與Kay 成形術(shù)的成形效果，總結(jié)治療經(jīng)驗(yàn)。 方法 回顧性分析江蘇省人民醫(yī)院2006 年1 月至2008 年1 月60 例功能性三尖瓣反流患者的臨床資料。按手術(shù)方式不同將60 例患者分為兩組：改良三尖瓣成形術(shù)組（改良組），30 例，其中男14 例，女16 例；年齡（42.80±5.70）歲；Kay 成形術(shù)組，30 例，其中男15 例，女15 例；年齡（45.30±8.30）歲。術(shù)前兩組患者的年齡、性別、心功能分級(jí)（NYHA）和三尖瓣反流分級(jí)差異均無(wú)統(tǒng)計(jì)學(xué)意義（P ＞ 0.05)。比較兩組患者術(shù)前、術(shù)后住院及術(shù)后隨訪期間的右心房橫徑、右心室舒張期末內(nèi)徑和三尖瓣反流面積。 結(jié)果 兩組患者手術(shù)時(shí)間、體外循環(huán)時(shí)間、住重癥監(jiān)護(hù)室時(shí)間、呼吸機(jī)輔助時(shí)間、住院時(shí)間差異均無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后全部患者痊愈出院。改良組隨訪時(shí)間為（19.62±8.65）個(gè)月，遠(yuǎn)期1 例死于肺部感染；隨訪三尖瓣無(wú)反流13 例，Ⅰ級(jí)反流14 例，Ⅱ級(jí)反流2 例，Ⅲ級(jí)反流1 例，無(wú)Ⅳ級(jí)反流。Kay 成形術(shù)組隨訪時(shí)間為（18.96±9.23）個(gè)月，遠(yuǎn)期死亡2 例，分別死于頑固性右心衰竭和腦出血；隨訪無(wú)三尖瓣反流9 例，Ⅰ級(jí)反流12 例，Ⅱ級(jí)反流5 例，Ⅲ級(jí)反流2 例，Ⅳ級(jí)反流2 例。術(shù)后早期改良組和Kay 成形術(shù)組右心房橫徑[（4.51±0.85）cm vs. (5.69±1.21) cm]、右心室舒張期末內(nèi)徑[（2.85±0.45） cm vs.（ 3.47±0.83） cm] 和三尖瓣反流面積[（4.17±2.54） cm2 vs.（ 25.12±2.39 cm2）] 較術(shù)前均明顯下降（P ＜ 0.05）；術(shù)后隨訪改良組和Kay成形術(shù)組右心房橫徑[（3.95±0.66） cm vs.（ 4.52±0.38） cm，P=0.705] 差異無(wú)統(tǒng)計(jì)學(xué)意義，右心室舒張期末內(nèi)徑[（2.59±0.63）cm vs.（ 2.98±0.47） cm， P=0.002] 和三尖瓣反流面積[（8.76±3.45） cm2 vs.（ 12.16±5.28） cm2， P=0.004] 改良組優(yōu)于Kay 成形術(shù)組。 結(jié)論 改良三尖瓣成形術(shù)的遠(yuǎn)期成形效果優(yōu)于Kay 成形術(shù)。

引用本文： 王俊,陳亮,陳廣明等. 改良三尖瓣成形術(shù)的效果評(píng)價(jià). 中國(guó)胸心血管外科臨床雜志, 2012, 19(1): 80-82. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)胸心血管外科臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1. 　Frater R. Tricuspid insufficiency. J Thorac Cardiovasc Surg, 2001, 122(3)：427-429.
2. 　Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease： incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5)：401-408.
3. 　De Vega NG, De Rábago G, Castillón L, et al. A new tricuspid repair. Short-term clinical results in 23 cases. J Cardiovasc Surg (Torino), 1973, Spec No： 384-386.
4. 　Kay GL, Morita S, Mendez M, et al. Tricuspid regurgitation associated with mitral valve disease： repair and replacement. Ann Thorac Surg, 1989, 48 (Suppl 3)： S93-S95.
5. 　Raja SG. Dreyfus GD. Surgery for functional tricuspid regurgitation： current techniques, outcomes and emerging concepts. Expert Rev Cardiovasc Ther, 2009, 7(1)： 73-84.
6. 　Lawrence SC, Gerald M, Ann FB, et al. Intraoperative evaluation of mitral regurgitation by doppler color flow mapping. Circulation, 1987, 76(3 Pt 2)：Ⅲ108-116.
7. 　Lambertz H, Flachskampf FA, Minale C. Tricuspid regurgitation in patients with mitral valve disease： who need tricuspid repair? Circulation, 1998, 78(2)：210-211.
8. 　Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2)：271-276.
9. 　Sugimoto T, Okada M, Ozaki N, et al. Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume： characteristic difference based on primary cardiac lesion. J Thorac Cardiovasc Surg, 1999, 117(3)：463-471.
10. 　Tei C, Pilgrim JP, Shah PM,et al. The tricuspid valve annulus： study of size and motion in normal subjects and in patients with tricuspid regurgitation. Circulation, 1982, 66(3)：665-671.
11. 　Silver MD, Lam JH, Ranganathan N, et al. Morphology of the human tricuspid valve. Circulation, 1971, 43(3)：333-348.
12. 　McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3)：674-685.
13. 　Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilation： Which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1)：127-132.
14. 　Xiao XJ, Huang HL, Zhang JF, et al. Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1)：65-69.
15. 　Porter A, Shapia Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement clinical an echocardiography evaluation. J Heart Valve Dis, 1999, 8(1)：57-62.
  1. 1. 　Frater R. Tricuspid insufficiency. J Thorac Cardiovasc Surg, 2001, 122(3)：427-429.
  2. 2. 　Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease： incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5)：401-408.
  3. 3. 　De Vega NG, De Rábago G, Castillón L, et al. A new tricuspid repair. Short-term clinical results in 23 cases. J Cardiovasc Surg (Torino), 1973, Spec No： 384-386.
  4. 4. 　Kay GL, Morita S, Mendez M, et al. Tricuspid regurgitation associated with mitral valve disease： repair and replacement. Ann Thorac Surg, 1989, 48 (Suppl 3)： S93-S95.
  5. 5. 　Raja SG. Dreyfus GD. Surgery for functional tricuspid regurgitation： current techniques, outcomes and emerging concepts. Expert Rev Cardiovasc Ther, 2009, 7(1)： 73-84.
  6. 6. 　Lawrence SC, Gerald M, Ann FB, et al. Intraoperative evaluation of mitral regurgitation by doppler color flow mapping. Circulation, 1987, 76(3 Pt 2)：Ⅲ108-116.
  7. 7. 　Lambertz H, Flachskampf FA, Minale C. Tricuspid regurgitation in patients with mitral valve disease： who need tricuspid repair? Circulation, 1998, 78(2)：210-211.
  8. 8. 　Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2)：271-276.
  9. 9. 　Sugimoto T, Okada M, Ozaki N, et al. Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume： characteristic difference based on primary cardiac lesion. J Thorac Cardiovasc Surg, 1999, 117(3)：463-471.
  10. 10. 　Tei C, Pilgrim JP, Shah PM,et al. The tricuspid valve annulus： study of size and motion in normal subjects and in patients with tricuspid regurgitation. Circulation, 1982, 66(3)：665-671.
  11. 11. 　Silver MD, Lam JH, Ranganathan N, et al. Morphology of the human tricuspid valve. Circulation, 1971, 43(3)：333-348.
  12. 12. 　McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3)：674-685.
  13. 13. 　Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilation： Which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1)：127-132.
  14. 14. 　Xiao XJ, Huang HL, Zhang JF, et al. Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1)：65-69.
  15. 15. 　Porter A, Shapia Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement clinical an echocardiography evaluation. J Heart Valve Dis, 1999, 8(1)：57-62.