二尖瓣置换术后左心室破裂的预防及治疗

目的分析二尖瓣置换术后左心室破裂发生的基本情况、转归及经验教训,探讨进一步提高诊治技术的方法及目前面临的困难。方法复习上海长海医院1990年1月~2008年12月期间4 489例接受二尖瓣置换及二尖瓣、主动脉瓣联合置换手术患者的临床资料,共有14例（0.3%）发生术后左心室破裂。其中早期破裂6例,延迟性破裂8例,Ⅰ型破裂1例,Ⅱ型破裂5例,Ⅲ型破裂8例。早期破裂6例,均在体外循环心脏停跳下进行修补,3例采用单纯心外缝合修补,3例采用心内及心外联合修补方法。延迟性破裂8例,均在监护室紧急开胸探查证实诊断,6例在床边缝合修补,2例暂时控制出血后回手术室修补,修补方式均为单纯心外修补。7例（50.0%）1次修补成功,因修复难度较大导致4例（28.6%）进行了2次修补,3例（21.4%）进行了3次及以上修补。结果 12例死亡,2例存活,存活者均为早期破裂患者,且均为采用心内及心外联合修补法的患者。结论对于左心室破裂的防治目前仍以预防为主,早期性破裂患者可综合应用多种方法提高治疗成功率,延迟性破裂者生存率极低,是目前治疗上面临的主要难题,尽早控制出血并恢复重要器官的血流灌注为改善预后的关键。

Precaution and Treatment of Left Ventricular Rupture after Mitral Valve Replacement

Objective This study is designed to analyze left ventricular rupture after mitral valve replacement through surgical therapeutic data base in valvular heart disease in order to discuss how to improve treatment technique and the difficulties.Method Between January 1990 and December 2008,4 489 patients underwent mitral valve replacement or double valve replacement operation in our hospital,there were altogether 14 patients complicated with left ventricular rupture.Result There were 6 patients of early rupture and the others were delayed rupture,all of the patients underwent emergent surgical repair,2 patients survived and both of them were early rupture.Conclusions At present precaution is still the best option to the left ventricular rupture,many synthetic methods are useful to improve achievement ratio.Survival rate of delayed rupture is very low and it＇s a tough problem to be faced with,control of hemorrhage and recover blood supply as soon as possible is the key point.