摘要:目的:探討改良De Vega環縮術與經典De Vega環縮術相比對于治療重度三尖瓣返流是否具有更好的成形效果。方法: 2007年12月至2009年3月對29例重度三尖瓣返流的患者行De Vega環縮術。其中16例行改良De Vega環縮術,13例行經典De Vega環縮術,隨訪比較兩組患者三尖瓣返流程度,右心室舒張期末內徑,EF值及心功能分級。以秩和檢驗分析研究兩組患者三尖瓣返流程度和心功能分級的差異,以t檢驗研究兩組患者右心室舒張末期內徑及EF值變化。結果:術前兩組患者一般指標無顯著差異。兩組患者隨訪時間無顯著差異。隨訪經典De Vega組重度返流1例,中度返流5例,輕度返流5例,微量及無返流2例;改良De Vega組無中、重度返流,輕度返流8例,微量及無返流8例。經分析顯示兩組患者三尖瓣返流程度結果差異有統計學意義(Plt;0.05)。經典De Vega組心功能分級I級5例,II級7例,III級1例;改良De Vega組I級7例,II級8例,III級1例,兩組患者心功能差異無統計學意義(Pgt;0.05)。兩組患者右室舒張期末內徑及EF值組內比較隨訪與術前差異均有統計學意義(Plt;0.05),隨訪時組間比較差異有統計學意義(Plt;0.05), 改良De Vega環縮術隨訪時右室舒張期末內徑縮小更顯著,射血分數改善更明顯。結論:改良De Vega環縮術治療重度三尖瓣返流效果優于經典De Vega環縮術。Abstract: Objective: To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique for the correction of severe tricuspid regurgitation. Methods: From December 2007 to March 2009, 29 patients were treated with tricuspid valve annuloplasty. These were 16 patients in modified De Vega annuloplasty group and the others (13 patients) in traditional De Vega annuloplasty group. The grade of tricuspid regurgitation、New York Heart Association (NYHA) functional class、ejection fraction (EF) and the right ventricular enddiastolic dimension of two groups were followed and reviewed. Results: There was no statistically difference between two groups about preoperative characteristics and followup time. There was 1 patient with severe TR, 5 patients with moderate TR, 5 patients with mild TR and 2 patients without TR in traditional De Vega annuloplasty group after the operations. In modified De Vega annuloplasty group, no patient was observed with severe or moderate TR, 8 patients with mild TR, and 8 patients without TR. At interval time, there was significant difference in the grade of tricuspid regurgitation between two groups (Plt;0. 05). Both tricuspid valve plasty techniques could reduce the right ventricular enddiastolic dimension and improve ejection fraction significantly (Plt; 0. 05), and there was significant difference in the right ventricular enddiastolic dimension and ejection fraction at interval time between two groups (Plt;0.05). Conclusions: The outcome of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in correcting severe tricuspid regurgitation.
目的 總結風濕性心瓣膜病三尖瓣關閉不全（ TI）手術治療的臨床經驗，以提高對該類患者的治療效果。 方法 1999年1月至2009年1月安徽醫科大學第一附屬醫院對167例風濕性心瓣膜病累及三尖瓣患者行手術治療，其中男76例，女91例；年齡16.0～75.0歲（40.7±10.4歲）；病程2.0～35.0年（13.2±3.8年）。112例輕度至中度三尖瓣反流采用改良或節段性De Vega成形術，40例中度或中度至重度三尖瓣反流采用Kay或改良Kay成形術；12例因瓣環擴張明顯、反流量大，行人工瓣環成形術，三尖瓣置換術3例。術后觀察三尖瓣反流情況，隨訪超聲心動圖結果。 結果 術后早期死亡6例，其中死于心搏驟停1例，腎功能衰竭2例，腦血管意外1例，心室破裂1例，縱隔感染致敗血癥1例。1例術中因低心排血量使用主動脈內球囊反搏（IABP）治療，治愈出院。隨訪159例，隨訪時間3～123個月，失訪2例。隨訪期間心功能分級(NYHA)Ⅰ級115例，Ⅱ級32例，Ⅲ級12例。三尖瓣輕度反流15例，中度反流5例，重度反流2例。隨訪期間三尖瓣隔瓣與前瓣瓣環間直徑（2.1±0.3 cm vs. 3.5±0.4 cm, P=0.000）、三尖瓣瞬時反流量(1.8±0.6 ml vs. 7.8±3.5 ml, P=0.001)和右心房容積（54.2±18.4 ml vs. 67.8±22.5 ml, P=0.012）較術前明顯減少或縮小； 射血分數（56.1%±7.2% vs. 54.3%±6.5%,P=0.313）較術前有所提高。 結論 心臟瓣膜病中TI需引起重視，應選擇適宜的方法積極治療。
