【摘要】 目的探讨三尖瓣适当切开技术(tricuspid valve detachment,TVD)在室间隔缺损(ventric-ular septal defect,VSD)修补手术中的临床价值。方法回顾性分析我院2006年1月～2010年12月行VSD修补的1 021例患者的临床资料,其中211例采用TVD技术(TVD组),810例未采用TVD技术(非TVD组)。所有患者在术前与术后3 d、1个月、6个月及1年行超声心动图观察心脏结构,评估三尖瓣返流(tricuspic regurgitation,TR)情况。结果 695例补片修补VSD,其中TVD组209例(128例使用单独缝线修补瓣叶切口,81例使用VSD补片缝线),非TVD组486例;另326例直接缝合VSD,其中TVD组2例(使用VSD补片缝线直接修补瓣叶切口),非TVD组324例。671例进行了合并畸形手术,其中TVD组115例(占TVD组54.5%),非TVD组556例(占非TVD组68.6%)。两组CPB时间、主动脉阻断时间及术后住院时间比较,均无统计学差异(P>0.05)。两组均无围手术期死亡病例。TVD组无完全性房室传导阻滞出现,非TVD组出现3例,均于术后10 d内恢复窦性。术后3 d VSD残余漏11例,其中TVD组3例,非TVD组8例;TVD组轻度以上的TR病例14例,非TVD组有47例。两组均无因TR和残余漏而再手术者。两组术后并发症发生率比较无统计学差异(8.1%VS 7.2%,P>0.05)。所有病人随访1年,无远期死亡病例,均无残余漏需远期再手术者。术后1年TVD组无轻度以上TR,非TVD组有8例轻度以上TR,组间比较差异无统计学意义(P>0.05)。两组均无因TR再手术者。结论 TVD是一种安全、有效的技术,能改善VSD的暴露,与传导阻滞、手术时间延长以及TR无相关性。TVD能保护三尖瓣瓣叶结构,减少术后严重TR的发生。更多还原

【Abstract】 Objective To investigate the clinical value of temporary tricuspid valve detachment(TVD) in the correlation of ventricular septal defect(VSD).Methods A total of 1 021 VSD patients admitted January 2006 to December 2010 in our hospital were analyzed retrospectively,including 211 of TVD(TVD group) and 810 of non-TVD(non-TVD group).All patients were observed cardiac structure and assessed tricuspid regurgitation(TR) by echocardiography in preoperative and three days,a month,6-month and 1-year postoperative.Results 695 cases were repaired with patch,including 209 of TVD group and 486 of non-TVD group.Another 326 cases were repaired by suturing VSD directly,including 2 of TVD group and 324 of non-TVD group.There was no statistic difference in cardiopulmonary bypass time,aorta blocking time and postoperative hospital stay between two groups(P>0.05).There was no peroperative death in both two groups.Complete atrioventricular block was 0 and 3,residual leak was 3 and 8,and tricuspid regurgitation was 14 and 47 in TVD group and non-TVD group respectively.There was no statistic difference in postoperative complication rate between two groups(8.1% VS 7.2%,P>0.05).All cases were followed up for one year without long-term death and reoperation associated with residual leakage.No case was found mild TR in TVD group,and 8 cases in non-TVD group,there was nostatistic difference between two groups(P>0.05).Conclusion TVD is a safe and effective technique for improving the VSD exposure,has no correlation with the atrioventricular block,surgical time and TR,and can protect the tricuspid valve leaflets structure and reduce the incidence of serious postoperative TR.更多还原