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Midterm outcomes of surgical treatment of traumatic severe tricuspid insufficiency



Midterm outcomes of surgical treatment of traumatic severe tricuspid insufficiency



Zhonghua Wai Ke Za Zhi 57(2): 134-138



目的: 探讨创伤性三尖瓣重度关闭不全外科治疗的时机及近中期效果。 方法: 回顾性分析2002年1月至2018年1月在首都医科大学附属北京安贞医院心外科接受外科手术的19例有明确致伤因素的重度三尖瓣关闭不全患者资料。男性12例,女性7例,年龄(43.1±12.9)岁(范围:17~68岁)。致伤原因包括交通事故所致胸部钝性伤17例,高处坠落撞击伤2例。超声心动图提示重度三尖瓣反流伴右心系统容量高负荷,手术前心功能(纽约心脏病协会分级)Ⅱ级5例,Ⅲ级12例,Ⅳ级2例。创伤至外科治疗间隔时间为12(90)个月(范围:0.1~228个月)。三尖瓣前叶腱索断裂9例,前叶乳头肌断裂3例,前、后叶腱索及乳头肌断裂4例,瓣叶及瓣环撕裂2例,合并感染性心内膜炎1例;均合并不同程度的瓣环扩大、右心房室扩大。手术技术遵循瓣膜修复优先的原则,按手术方式分为瓣膜修复组和瓣膜置换组。采用秩和检验比较瓣膜修复组与瓣膜置换组从创伤至外科治疗间隔时间,采用配对t检验比较手术前及随访时超声心动图表现。 结果: 实施瓣膜修复术8例,瓣膜置换术11例,其中采用机械瓣6例,生物瓣5例。三尖瓣成形组及三尖瓣置换组从创伤至外科治疗间隔时间分别为8.5(10.0)个月(范围:0.1~13.0个月)及72.0(108.0)个月(范围:2.0~228.0个月),两组差异有统计学意义(Z=-2.48,P=0.013)。围手术期死亡1例,死于爆发性肝炎所致的肝功能衰竭,其余均顺利出院。18例存活患者全部获得随访,随访(94±50)个月(范围:8~192个月),心功能Ⅰ级15例,Ⅱ级3例,因机械瓣膜功能障碍再次行瓣膜置换1例。 结论: 创伤性三尖瓣重度关闭不全外科手术治疗的近、中期效果较好,早期诊断及治疗有助于提高瓣膜修复率。.

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Accession: 066446337

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PMID: 30704218


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