| 陈浩 刘伟 胡小平 王宏宇 曹建军.冠心病合并左心室室壁瘤的手术治疗分析[J].,2016,16(6):1115-1117 |
| 冠心病合并左心室室壁瘤的手术治疗分析 |
| Surgical Treatment of Coronary Heart Disease Combinedwith Left Ventricular Aneurysm |
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| DOI： |
| 中文关键词: 冠心病 室壁瘤 冠脉搭桥 左室成形 |
| 英文关键词: Coronary heart disease Left ventricular aneurysm Coronary artery bypass graft Ventricle remodeling |
| 基金项目:中央高校基本科研业务费专项资金项目青年教师资助项目（2042014kf0117）；十堰市科技局指导项目（ZD2012035） |
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| 中文摘要: |
| 目的：分析和探讨冠心病合并室壁瘤的外科手术治疗的方法。方法：2008 年1 月至2014 年3 月我科共收治37 例冠心病合
并左心室室壁瘤患者，均在体外循环下行冠脉搭桥术，室壁瘤直径小于50 mm采用"三明治" 法室壁瘤折叠术（13 例），室壁瘤直
径大于50 mm 采用Dor 标准术式（24 例）；同期行二尖瓣置换术5 例，二尖瓣成形术3 例，三尖瓣成形术4 例，主动脉瓣置换术3
例。比较术前、术后2 周及术后一年患者左心室舒张末期内径、左室射血分数、NYHA心功能分级，评价手术治疗效果。结果：所有
病例均手术成功，前降支均采用左乳内动脉作为桥血管，移植血管1-4 支。术后1 例因肺部感染死亡，1 例猝死，其余均康复出院。
术后血胸再次开胸止血1 例。随访34 例，1 例失访。术后2 周、术后1 年患者左室射血分数（LVEF）(44.27± 7.22) %、(49.32± 6.98)
%较术前(34.47± 8.13) %明显改善，左室舒张末期直径（LVEDD）（51.87± 6.25）mm、（50.73± 5.72）mm）较术前（61.25± 5.21）mm
明显改善，心功能分级（1.82± 0.47）、(1.64± 0.51）较术前（3.08± 0.55）明显改善，上述差异均有统计学意义（P＜ 0.05）。结论：对冠
心病合并室壁瘤患者，根据瘤体大小及部位选择不同手术方式，并同期冠脉搭桥及矫治瓣膜功能障碍，临床疗效满意。 |
| 英文摘要: |
| Objective:To analyze and investigate the methods of surgical treatment for coronary heart disease (CHD) combined
with left ventricular aneurysm.Methods:The clinical data of 37 patients with CHD combined with left ventricular aneurysm were
retrospectively analyzed. All of the patients were treated with coronary artery bypass graft under cardiopulmonary bypass. The
concomitant procedures included 13 cases of improved placation, 24 cases of Dor procedure, 5cases of mitral valve replacement, 3 cases
of mitral valvuloplasty, 4 cases of tricuspid valvuloplasty, 3 cases of aortic valve replacement. The left ventricular end-diastolic
dimension (LVEDD), left ventricular ejection fraction (LVEF) and NYHA heart function classification were compared in all patients
before operation, 2 weeks after operation and 1 year after operation to evaluate the effect of surgical treatment.Results:All the 37
patients were successfully operated, and the numbers of graft applied ranged from 1 to 4. 2 patients died after operation due to the
pulmonary infection or sudden death. One patient underwent re-thoracotomy exploration because of postoperative hemothorax. LVEF
was significantly higher 2 weeks after operation (44.27± 7.22) % and 1 year after operation(49.32± 6.98) %) than that before operation
(34.47± 8.13)% (P＜0.05). LVEDD was significantly shorter 2 weeks after operation（51.87± 6.25）mm and 1 year after operation
（50.73± 5.72）mm than that before operation（61.25± 5.21）mm (P＜0.05) . NYHA was significantly higher 2 weeks after operation
(1.82± 0.47) and 1 year after operation (1.64± 0.51) than that before operation（3.08± 0.55）(P＜0.05).Conclusion:In the treatment of
CHD combined with left ventricular aneurysm, the different surgical management should be selected according to the position and
diameter of left ventricular aneurysm. Concomitant revascularization and valve repair can gain a fine clinical curative effects. |
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