目的评价使用三尖瓣成形环与改良De Vega成形术治疗功能性三尖瓣关闭不全的临床疗效。方法选取2015年6至9月兰州大学第一医院收治的40例功能性三尖瓣关闭不全患者，随机分为两组，其中改良De Vega成形组20例，采用改良De Vega成形术；成形环组20例，采用进口Edwards4600成形环行三尖瓣成形术。分别于术后1周、1个月、3个月进行复查随访，根据心功能评估和超声心动图检查指标，通过测量两组患者术前与术后右心房横径、右心室内径、三尖瓣跨瓣压差以及三尖瓣反流束面积等指标，对比两组不同三尖瓣成形术式的成形效果及临床疗效。结果改良De Vega组术前：右心房横径为（50.12±10.34）mm、右心室内径为（28.47±6.35）mm、三尖瓣跨瓣压差为（39.56±7.84）mmHg、三尖瓣反流束面积/右心房面积为23.98%±5.42%；术后：右心房横径为（32.63±6.53）mm、右心室内径为（24.64±4.67） mm、三尖瓣跨瓣压差为（30.76±5.96） mmHg、三尖瓣反流束面积/右心房面积为4.10%±2.35%；人工软环成形组术前：右心房横径为（45.30±7.95）mm、右心室内径为（24.10±4.71）mm、三尖瓣跨瓣压差为（41.15±9.65）mmHg、三尖瓣反流束面积/右心房面积为22.75%±6.52%；术后：右心房横径为（35.25±6.67）mm、右心室内径为（21.60±2.99）mm、三尖瓣跨瓣压差为（26.00±6.67）mmHg、三尖瓣反流束面积/右心房面积为3.90%±1.89%。两组患者术后右心房横径、右心室内径较术前显著缩小，三尖瓣跨瓣压差、三尖瓣反流束面积/右心房面积较术前明显降低（P＜0.05），但两组患者上述指标组间比较差异无统计学意义（P＞0.05）。结论 De Vega 成形术与三尖瓣人工软环成形术治疗功能性三尖瓣关闭不全均有显著疗效，能显著降低三尖瓣反流，术后右心房横径、右心室内径较术前明显缩小。但两种不同术式的短期临床疗效相似。%ObjectiveTo evaluate the clinical efficacy of tricuspid annuloplasty ring and the modified De Vegatricuspid annuloplasty for the treatment of functional tricuspid regurgitation.MethodsA total of 40 patients withfunctional tricuspid from June 2015 to September2015 in our hospitalwere involved in this study. The patients were randomly divided into two groups, modified De Vega tricuspid annuloplasty group(n=20) and tricuspid annuloplasty ring group(n=20, treated with imported Edwards4600 tricuspid annuloplasty ring). All patients were reviewed and followed-up in 1 week, 1 month and 3 months after operation.The clinical efficacy wasevaluatedby the diameter of right atrium,the diameter of ventriculus dexter,the differential pressure of tricuspid valve and the reverse flow of tricuspid valve.ResultsDe Vega group pre-operation indexes: right atrium diameterwas (50.12±10.34)mm,right ventricular internal dimensionwas(28.47±6.35)mm,tricuspid valve differential pressurewas(39.56±7.84)mmHg,tricuspid regurgitation in beam area/right atrium areawas 23.98%±5.42%, postoperation indexes: right atrium diameterwas(32.63±6.53)mm,right ventricular internal dimensionwas(24.64±4.67)mm,tricuspid valve differential pressurewas(30.76±5.96)mmHg,tricuspid regurgitation in beam area/right atrium areawas4.10%±2.35%.Tricuspid annuloplasty ring group pre-operation indexes: right atrium diameterwas(45.30±7.95)mm,right ventricular internal dimensionwas(24.10±4.71)mm, tricuspid valve differential pressurewas(41.15±9.65)mmHg,tricuspid regurgitation inbeam area/right atrium areawas22.75%±6.52%, postoperation indexes: right atrium diameterwas(35.25±6.67)mm,right ventricular internal dimensionwas(21.60±2.99)mm,tricuspid valve differential pressurewas(26.00±6.67)mmHg,tricuspid regurgitation inbeam area/right atrium areawas3.90%±1.89%. There were obvious improvements in all of the postoperative indexescompared withpreoperativeindexesin both groups (P<0.05), but there wereno statistically significant differencesbetween the two groups (P>0.05).ConclusionBoth of the tricuspid annuloplasty ring and the modified De Vega tricuspid annuloplastyhavea significant efficacy for functional tricuspid regurgitation. However, the short-term clinical efficacy of two different surgical methodsis similar.
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