二尖瓣成形术治疗儿童二尖瓣关闭不全的疗效分析

An analysis of the effect of mitral valvuloplasty in the treatment of children with mitral insufficiency

摘要:

目的：探讨二尖瓣成形术在儿童二尖瓣关闭不全的治疗效果。方法：回顾性研究2008年7月1日至2018年7月1日于重庆医科大学附属儿童医院行二尖瓣成形术的135名患儿临床资料，其中男55名，女80名。手术方式包括二尖瓣交界成形术（90例）、瓣环环缩成形（13例）、裂缺缝合（29例）、双孔二尖瓣（20例）、腱索缩短术（5例）、三角切除术（5例）。若合并其他心内畸形，则一并矫正。采用配对t检验对比术前及术后超声心动图中反流程度、左房内径（left atrial diameter，LAD）、左室舒张期末内径（left ventricular end-diastolic diameter，LVDd）、左室收缩期末内径（left ventricular end-systolic diameter，LVDs）和左室射血分数（left ventricular ejection fraction，LVEF）等来评估手术效果。结果：135名患儿均顺利完成手术，术中无死亡病例。院内死亡率为5.2%，二次手术率为2.3%，剩余125名患儿门诊随访，失访率为8.8%，平均随访时间（18.2±15.2）个月。患儿术后平均LAD[（20.0±5.8） mm]、LVDd[（33.7±6.3） mm]、LVDs[（21.6±4.9） mm]较术前明显减小（P=0.000），LVEF[（68.7±4.6）%]较术前提高（P=0.000），差异有统计学意义。术后82.5%的患儿反流程度降至中度或以下。结论：二尖瓣成形术在儿童二尖瓣关闭不全的治疗中手术效果确切，并发症少，可作为首选术式。若合并其他心内畸形，可同期矫治，效果良好。

Abstract:

Objective：To investigate the effect of mitral valvuloplasty in the treatment of children with mitral insufficiency. Methods：A retrospective analysis was performed on the clinical data of 135 children（55 males and 80 females） who had undergone a mi－tral valvuloplasty in Children’s Hospital of Chongqing Medical University from July 1，2008 to July 1，2018. The surgical ap－proaches included mitral commissurotomy（90 cases），annuloplasty（13 cases），cleft suture（29 cases），double-orifice valve repair（20 cases），shortening of chordae tendineae（5 cases），and triangular resection（5 cases）. Concomitant intracardiac anomalies were treated simultaneously if present. The paired t-test was used to evaluate the effect of the operation by comparing the following preopera－tive and postoperative results：degree of regurgitation，left atrial diameter（LAD），left ventricular end-diastolic diameter（LVDd），left ventricular end-systolic diameter（LVDs），and left ven－tricular ejection fraction（LVEF）. Results：All of the 135 chil－dren had a successful operation，and no death occurred during the operation. The in-hospital mortality rate was 5.2%，and the reoperation rate was 2.3%；125 children remained in the clinic follow-up，with a loss to follow-up rate of 8.8%；the mean fol－low-up duration was （18.2±15.2） months. After the operation，there were significant reductions in the mean values of LAD，LVDd，and LVDs[（20.0±5.8） mm，（33.7±6.3） mm，and （21.6±4.9） mm，respectively，P=0.000]，and a significant increase in LVEF [（68.7±4.6）%，P=0.000]；82.5% of the children had their regurgitation reduced to a moderate or lower degree. Conclusion：Mitral valvuloplasty has a definitive effect in the treatment of children with mitral insufficiency with few complications observed，which makes it the optimal surgical approach for the disease；other concomitant intracardiac anomalies can be simultaneously treated if pre－sent，with a good outcome to be expected.