三尖瓣关闭不全的外科治疗

目的探讨三尖瓣关闭不全（TI）外科治疗的手术特点、方法和疗效。方法 2000年1月~2009年2月,我院行手术治疗TI患者262例,其中器质性TI 16例,功能性TI 246例,手术采用三尖瓣成形术（TVP）257例,三尖瓣置换术（TVR）5例。结果术后早期死亡10例,手术病死率为3.82%。术后随访116例,平均随访时间（31.5±11.1）个月。远期死亡3例,余113例远期存活者心功能Ⅰ级者23例,Ⅱ级者71例,Ⅲ级者15例,Ⅳ级者4例。结论无论是器质性或功能性TI,多数可以行TVP,对无法行成形术的患者应行TVR。右心衰竭与心律失常是三尖瓣手术早期和晚期死亡的重要原因,围手术期应加强右心功能的维护和心律失常的防治。

Surgical treament of tricuspid insufficiency

Objective To assess the occasion,method and effect of surgical treatment of tricuspid insufficiency.Methods From January 2000 to February 2009,262 cases of tricuspid valve operations were performed for tricuspid insufficiency,which included 16 cases of organic tricuspid insufficiency and 246 cases of functional tricuspid insufficiency.of all the patients,257 cases underwent valvuloplasty and 5 cases valve replacement.Results Ten patients died early after operation,operative mortality was 3.82%.Average following-up was（31.5±11.1） months in 116 patients.Long-term death was three patients,for the rest 113 survivors,their function was classified as follows：class Ⅰ 23 cases,class Ⅱ 71 cases,class Ⅲ 15 cased and class Ⅳ 4 cases.Conclusion The valvuloplasty is indicated for most of organic or functional tricuspid insufficiency.For those the plasty can′t be done,valve replacement is advocated.Right heart failure or arrhythmia is the predominant cause of early and long-term death,which should be carefully protected and managed perioperatively.