2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：1-3国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434“缘对缘”技术在瓣膜成形术中的应用来永强首都医科大学附属北京安贞医院心脏外科,100029摘　要:随着心肌保护、体外循环技术及术后管理的进步，二尖瓣置换的手术成功率及远期疗效均有明显的提高。进行性发展的二尖瓣关闭不全会引起左心房及左心室扩大，左室充盈压升高及左室后负荷减低；若不及时治疗，病变会引起心功能不全，心力衰竭甚至猝死。对于二尖瓣关闭不全，二尖瓣成形术仍是首选的治疗方法。二尖瓣成形能维持心脏的几何形态，保护心室功能，明显降低手术死亡率，降低术后心内膜炎及血栓发生率，具有良好的长期生存率，治疗效果明显优于二尖瓣置换术。[第一段]

关键词:瓣膜成形术 二尖瓣关闭不全 二尖瓣成形术 二尖瓣置换术 体外循环技术 心肌保护 治疗方法 手术成功率
分类号:　R654.2

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：4-7国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434“缘对缘”三尖瓣成形在纠治残留三尖瓣关闭不全的应用来永强 白涛 孟旭 张纯 罗毅 张兆光首都医科大学附属北京安贞医院心脏外科,100029摘　要:目的总结“缘对缘”三尖瓣成形方法治疗重度残留三尖瓣关闭不全的经验。方法19例常规三尖瓣成形术后仍有重度残留三尖瓣关闭不全者接受“缘对缘”三尖瓣成形术。三尖瓣关闭不全的病因包括：风湿性心脏病7例、先天性心脏病8例、创伤性及退行性变各2例。结果住院死亡1例，9例术后无或仅有微量三尖瓣关闭不全，10例术后轻度三尖瓣关闭不全。随访3～60个月，平均36．6个月，16例为微量到轻度三尖瓣关闭不全，2例为轻度到中度三尖瓣关闭不全。结论“缘对缘”三尖瓣成形是纠治重度残留三尖瓣关闭不全的一种有效的辅助方法。[著者文摘]

关键词:三尖瓣闭锁不全 心脏外科手术
分类号:　R654.2[机标]文献标识码：文章编号：栏目信息：瓣膜外科
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Correction of residual tricuspid regurgitation with edge-to-edge tricuspid valve repair LAIYong-qiang, BAI Tao, MENG Xu, el al. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, ChinaAbstract:Objective Tricuspid regurgitation is a very common valve disease. Significant morbidity and mortality is associated with tricuspid valve replacement and tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique in cases with severe residual tricuspid regurgitation. Methods From Apr. 2001 to Jun. 2006, 19 patients with severe residual tricuspid regurgitation underwent edge-to-edge tricuspid valve plasty. The etiology of tricuspid regurgitatinn was secondary to rheumatic heart disease in seven cases, secondary to congenital heart disease in eight cases, post-traumarie and degenerative in two cases respectively. Severe tricuspid regurgitation was still present after tricuspid valve repair was performed with traditional methods. Edge-to-edge tricuspid valve plasty was applied in these patients. Results There was one hospital death. No or trivial tricuspid regurgitation was found in 9 cases and mild tricuspid regurgitation was present in 10 cases after operation. The follow-up ranged from 3 months to 60 months （median 36.6 months）. Trivial to mild TR was present in 16 cases and mild to moderate TR in 2 cases. Conclusion Edge-to-edge tricuspid valve plasty is an effective adjuvant procedure for patients who have severe residual tricuspid regurgitation.[著者文摘]

Key words:Tricuspid valve insufficiency Cardiac surgical procedure

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：7-7国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434钝性胸部伤致胸导管断裂1例刘喜龙[1] 张莉娜[1] 曹占有[2] 金秀琴[2] 张国良[3][1]通辽市开鲁县医院外科,内蒙古028400 [2]内蒙古民族大学附属医院胸外科 [3]北京大学人民医院胸外科,100044摘　要:胸导管走行于胸内重要结构之间，且其直径仅有2～4，所以胸部穿透伤引起的单纯胸导管损伤极其罕见，胸部钝性创伤引起的乳糜胸亦很少见。我们遇到车祸后右下胸背部软组织挫伤合并单纯胸导管损伤1例，现报道如下。[第一段]

关键词:钝性胸部伤 导管断裂 胸导管损伤 胸部穿透伤 软组织挫伤 钝性创伤 乳糜胸 胸背部
分类号:　R655

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：8-10国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434二尖瓣成形术对轻中度缺血性二尖瓣关闭不全中期疗效的影响隋亮 赵强复旦大学附属中山医院心外科,上海200032摘　要:目的评价单纯冠状动脉旁路移植术和同期加二尖瓣成形术对轻中度缺血性二尖瓣关闭不全（IMR）中期疗效的影响。方法1999年8月至2004年8月手术后生存的术前轻中度IMR病人60例，其中冠状动脉旁路移植术同期二尖瓣成形术（MVP组）和单纯冠状动脉旁路移植术（C组）各30例，分析术前资料，包括年龄、性别、二尖瓣反流程度、心功能、左心形态及左心室射血分数（LVEF）等，利用超声心动比较术后中期心功能和左心形态改善情况，利用生活质量评估表（SAQ量表）评价两组生活质量的改变。结果中期生存率MVP组为96．7％，C组为92．6％，两组差异无统计学意义。MVP组术后左心房内径缩小，C组左心房内径增大（P〈0．05），左心室内径改变两组差异无统计学意义。两组病人LVEF较术前均改善，但MVP组明显优于C组（P〈0．05）。MVP组术后生活质量明显优于C组病人，SAQ总得分分别为66．18和58．20（P〈0．05）。结论冠状动脉旁路移植术同期二尖瓣成形术可以明显提高轻中度IMR病人中期预后、生存率和生活质量，中期疗效优于单纯冠状动脉旁路移植术；[著者文摘]

关键词:二尖瓣闭锁不全 冠状动脉分流术 心脏外科手术 生活质量
分类号:　R654.2[机标]文献标识码：文章编号：栏目信息：瓣膜外科
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The intermediate outcome of mitral valvuplasty in treatment of moderate ischemic mitral regurgitationSUI Ling, Zhao QiangDepartment of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, ChinaAbstract:Objective To determine whether mitral valvuplasty （MVP） concomitant with CABG was preferable to CABG alone in patients with moderate IMR in terms of intermediate outcome. Methods Case-match study was carried out in sixty patients who were with moderate IMR and were tmdertaken either CABG with MVP （n = 30, MVP group） or CABG alone （n = 30, C group）. Two groups were homogeneous for preoperative characteristics and comorbidities, such as age gender, severity of MR and New York Heart Association （NYHA） class. The postoperative changes of heart function, survival rate and life quality between the two groups were compared respectively. Results The intermediate survival rate of patients in the C group and MVP group were 92.6 % and 96.7 %, respectively, The improvement of LVEF in MVP group was more obviously than that in C group. Score of SAQ measuring scale in group C was 58.20 ± 14.52, which was lower titan that in MVP group （ 66.18 ± 7.87 ）. Patients in MVP group also had a better NYHA class at intermediate follow-up titan patients in C group. Conclusion The results of this case-match study showed that in a l＇mmageneous series of patients with moderate IMR, MVP at the time of CABG leads to a better clinical results than CABG alone.[著者文摘]

Key words:Mitral valve insufficiency Coronary artery bypass Cardiac surgical procedure Quality of life

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：11-13国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-24345066例瓣膜手术的围术期临床回顾孟旭 白涛首都医科大学附属北京安贞医院心外科,100029摘　要:目的回顾分析安贞医院1993～2004年5066例心脏瓣膜手术围术期资料，探讨我国瓣膜外科围术期临床特点。方法利用自行研发的心外科专业数据库，将所有病例资料依据手术种类、心脏大小、心功能及EF值变化、手术相关数据（体外循环时间、主动脉阻断时间、呼吸机带管时间、ICU时间、术后住院并发症）、病死率、并发症分布等进行分组，应用t检验和X^2检验来比较各组间的差异。结果全组手术后围术期并发症发生率为18．2％，总病死率4．6％。统计显示，病人平均年龄逐年升高；风湿性心脏病仍是病因的构成主体，但近5年来退行性病变、黏液性病变比例明显增加；围术期病死率近年来已稳定在3％～4％。结论瓣膜外科年龄构成有明显的上升趋势；围术期应针对老年病人特点进行管理；EF值在不同病理改变的瓣膜病中，对围术期病死率的影响意义并不相同；应重视瓣膜成形技术的开展；应加强对专业数据库系统的开发和应用。[著者文摘]

关键词:心脏瓣膜疾病 心脏瓣膜假体植入 手术期间 预后
分类号:　R654.205[机标]文献标识码：文章编号：栏目信息：瓣膜外科
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A retrospective study of perioperative risk factors in 5066 cases of valve replacementMENG Xu, BAI TaoDepartment of Cardiac Surgery, Beifing Anzhen Hospital, Capital Medical University, Beijing 100029, China Abstract:Objective To identify some perioperative risk factors of valve surgery. Methods A retrospective review was performed about 5066 cases of valve replacement in Anzhen Hospital from 1993 to 2004. All the data were reviewed including classification of valve procedures, overall cardiac size, heart function, EF, CPB time, cross-clamping time, intubation time, the stay in ICU, the stay in hospital, mortality rate and comphcation distribution. T test and X^2 statistic were used to assess the association of factors. The prevalence of perioperative complication was 18.2%, whereas the total mortality was about 4.6 %. The data showed that the average age of patients rose annually since 2000. Rheumatic heart disease was still the common cause of valve surgery while the prevalence of degenerative valve disease and commitant CABG rose recently. The perioperative mortality rate stabilized at the 3% - 4% in recent years. Conclusion The distribution of age tended to be elder and more attention should be paid to the perioperatire management of elder patients. EF value had different effects on the outcome according to the variety of pathologic changes in valve diseases. The valve repair was relatively rare in domestic compared with the West, which should be paid more attention to in future. The doenmentary system of cardiac surgery played very important role in the analysis and development of the database in china.[著者文摘]

Key words:Heart valve diseases Heart valve prosthesis implantation Intraoperative period Prognosis

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：13-14国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434二尖瓣狭窄球囊瓣膜成形术后瓣膜再手术33例金海 邹良建 徐志云 于伟勇 梅举 王志农 张宝仁上海第二军医大学长海医院胸心外科,200433摘　要:1998年1月至2004年12月期间，我们共手术治疗二尖瓣狭窄球囊瓣膜成形（PMBV）术后瓣膜病变复发33例，均再施行了瓣膜置换手术，现就其手术适应证、病理改变以及手术方法进行讨论如下。[第一段]

关键词:球囊瓣膜成形术 二尖瓣狭窄 再手术 瓣膜置换手术 手术适应证 瓣膜病变 手术治疗 手术方法
分类号:　R654.2

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：15-17国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-24341003例瓣膜置换手术围手术期处理刘健 袁忠祥 肖明第上海市第一人民医院心胸外科,200080摘　要:目的总结1003例心脏瓣膜置换手术病例临床特点及围手术期处理经验。方法手术在体外循环中度低温下进行，其中单纯二尖瓣置换术（MVR）555例，主动脉瓣及二尖瓣置换术（BVR）273例，主动脉瓣置换术（AVR）139例，三尖瓣置换术（TVR）26例，三瓣置换术10例。全组病人按≤40岁、41—59岁、≥60岁分为3组，分别为152、572、279例。结果975例（97．2％）恢复出院，死亡28例（2．8％）。3组死亡率分别为3．3％，1．7％，4．7％。死因分别为呼吸循环衰竭11例、多脏器功能衰竭10例、室性心律失常5例、肾功能衰竭2例。发生各种并发症74例次。结论瓣膜置换术是治疗瓣膜病变的有效手段，选择适当的手术时机，改进和完善体外循环技术，加强术中心肌保护，不断改进和提高手术技巧，尽量保留瓣下结构的二尖瓣置换术，能减少瓣膜置换术的手术风险，提高手术疗效。主动脉瓣置换时应尽量去除钙化的瓣叶，置入大一号的瓣膜，减少跨瓣压差，有利于左室重构。术中应常规探查三尖瓣，对瓣环明显扩大的病人予以三尖瓣成形术。心脏大的病人尤应注意围术期电解质的变化，防止发生恶性心律失常。生物瓣的术后抗凝较机械瓣方便，并发症也少，应提高生物瓣的应用比例。围手术期处理得当，可减少术后并发症及降低病死率，老年病人术前合并症多、病情重，应加强围手术期监护。[著者文摘]

关键词:心脏瓣膜疾病 心脏瓣膜假体植入 围手术期医护
分类号:　R654.2[机标]文献标识码：文章编号：栏目信息：瓣膜外科
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Perioperative management of 1 003 cases of heart valve replacementLIU Jian, YUAN Zhong-xiang, XIAO Ming-diDepartment of Cardiovascular Surgery, Shanghai First People＇ s Hospital, Shanghai 200080, ChinaAbstract:Objective To review the experience of 1 003 cases heart valve replacement operations from August 1997 to July 2005. Methods All 1 003 cases were underwent heart valve replacement under hypothermia and CPB, MVR 555 cases, BVR 273 cases, AVR 139 cases, TVR 26 cases, both BVR and TVR 10 cases. All cases were divided into three groups according to age≤40 years,40 - 60 years, 960 years, respectively. Results 975 cases （97.2% of all cases） recovered and discharged. There were 75 postoperative complicafions, including 28 deaths （mortality of 2.8%）. The mortality rate of three groups was 3.3%, 1.7% and 4.7%, respectively. The major causes of early death were ventricular arrhythmia, respiratory, circulatory failure, renal failure and multiple organ failure, respectively. Conclusion Valve replacement is an effective remedy for valve disease. Operative complication and mortality rate can be significantly decreased by correct perioperative management. Eider patients have mere combinations and their illness is more serious. More attention should be paid perioperative management.[著者文摘]

Key words:Heart valve diseases Heart valve prosthesis implantation Perioperative care

2007年 23卷 1期《 中华胸心血管外科杂志 》
Chinese Journal of Thoracic and Cardiovascular Surgery起止页码：17-18国际标准刊号：ISSN 1001-4497国内统一刊号：CN 11-2434二尖瓣再次手术159例郑奇军 易定华 俞世强 陈文生 李彤 王红兵 蔡振杰第四军医大学西京医院心脏外科,西安710032摘　要:1998年1月至2005年8月，我们为159例二尖瓣闭式扩张术后、瓣膜成形术后、瓣周漏及生物瓣衰败等病人行二尖瓣再次手术，现总结报道如下。[第一段]

关键词:二尖瓣闭式扩张术 再次手术 瓣膜成形术 生物瓣衰败 瓣周漏
分类号:　R654.2