引用本文:钟丽珊，黄燕莹，汪珍忠，肖　硕，李玉欣，方　斗，王秋吉，张朝龙，黄焕雷.1 275例二尖瓣反流患者行全胸腔镜微创二尖瓣成形术的长期随访结果分析[J].中国临床新医学,2024,17(3):244-251.
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1 275例二尖瓣反流患者行全胸腔镜微创二尖瓣成形术的长期随访结果分析
钟丽珊1，黄燕莹1，2，汪珍忠1，肖　硕3，4，李玉欣4，方　斗4，王秋吉4，张朝龙2，4，黄焕雷1，4
1.广东省心血管病研究所，南方医科大学附属广东省人民医院（广东省医学科学院），广州 510080；2.广东省心血管病研究所，广东省人民医院，广东省医学科学院，广州 510080；3.华南理工大学医学院，广州 510006；4.南方医科大学附属广东省人民医院（广东省医学科学院）心外科，广州 510080
摘要:
［摘要］　目的　明确全胸腔镜微创二尖瓣成形术（TCMI-MVP）在治疗二尖瓣反流（MR）的安全性、有效性和耐久性。方法　回顾性分析2009年1月1日至2022年6月1日在广东省人民医院接受TCMI-MVP的1 275例MR患者的中远期结果。根据随访结果将患者分为MR未复发组（A组，1 098例）和MR复发组（B组，177例），比较两组术前、术中、术后资料以及随访情况。结果　随访率为96.24%，中位随访时间为4.42（0.00，13.20）年。整个队列患者1年、3年、5年和10年的生存率分别为99.5%、98.5%、97.8%和95.5%。两组生存预后差异无统计学意义（χ2=0.350，P=0.554）。当未考虑死亡为竞争风险时，整个队列患者1年、3年、5年和10年MR≥2+的复发豁免率分别为90.4%、87.4%、85.6%和78.3%。当考虑死亡为竞争风险时，术后进展为MR≥2+的累积发生率在1年、3年、5年和10年时，分别为9.6%、12.5%、14.3%和21.4%。通过多因素Cox回归分析发现，患有高血压［HR（95%CI）=1.70（1.18～2.44），P=0.004］、同时行三尖瓣成形手术［HR（95%CI）=1.65（1.16～2.36），P=0.006］、较大的术前左心室收缩末期内径［HR（95%CI）=1.09（1.03～1.15），P=0.002］、较大的术后1周左心房内径［HR（95%CI）=1.03（1.01～1.06），P=0.031］和术后1周MR分级程度高［HR（95%CI）=59.63（21.84～162.82），P<0.001］是MR复发的危险因素。总体患者1年、3年、5年和10年再次二尖瓣手术的豁免率分别为99.6%、98.9%、98.7%和97.9%。结论　先进瓣膜中心合理地运用各项修复技术行TCMI-MVP是安全、有效的，可获得良好的远期修复效果。
关键词:  二尖瓣反流  全胸腔镜微创  二尖瓣成形术
DOI：10.3969/j.issn.1674-3806.2024.03.02
分类号:
基金项目:国家自然科学基金面上项目（编号：82270373）；广东省省级科技计划项目（编号：2020B1111170011）；广东省基础与应用基础研究基金重点项目（编号：2019B1515120071）；广州市卫生健康委员会项目（编号：2023FTJCZ0011）
Analysis on the long term results of total thoracoscopic minimally invasive mitral valvuloplasty in 1 275 patients with mitral regurgitation
ZHONG Lishan1, HUANG Yanying1,2, WANG Zhenzhong1, XIAO Shuo3,4, LI Yuxin4, FANG Dou4, WANG Qiuji4, ZHANG Chaolong2,4, HUANG Huanlei1,4
1.Guangdong Cardiovascular Institute, Guangdong Provincial People′s Hospital of Southern Medical University(Guangdong Academy of Medical Sciences), Guangzhou 510080, China; 2.Guangdong Cardiovascular Institute, Guangdong Provincial People′s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; 3.South China University of Technology School of Medicine, Guangzhou 510006, China; 4.Department of Cardiac Surgery, Guangdong Provincial People′s Hospital of Southern Medical University(Guangdong Academy of Medical Sciences), Guangzhou 510080, China
Abstract:
［Abstract］　Objective　To clarify the safety, efficacy and durability of total thoracoscopic minimally invasive mitral valvuloplasty(TCMI-MVP) in the treatment of mitral regurgitation(MR). Methods　The medium and long term results of 1 275 MR patients who received TCMI-MVP in Guangdong Provincial People′s Hospital from January 1, 2009 to June 1, 2022 were retrospectively analyzed. The patients were divided into non-recurrent MR group(group A, 1 098 cases) and recurrent MR group(group B, 177 cases) according to the follow-up results. The preoperative, intraoperative and postoperative data and the follow-up results were compared between the two groups. Results　The follow-up rate was 96.24%, and the median follow-up time was 4.42(0.00,13.20)years. The 1-, 3-, 5- and 10-year survival rates of the patients in the entire cohort were 99.5%, 98.5%, 97.8% and 95.5%, respectively. There was no significant difference in survival prognosis between the two groups(χ2=0.350, P=0.554). When death was not considered as a competing risk, the recurrent exemption rates of the patients for MR≥2+ at 1 year, 3 years, 5 years and 10 years were 90.4%, 87.4%, 85.6% and 78.3% in the entire cohort, respectively. When death was considered as a competing risk, the cumulative incidence rates of postoperative progression with MR≥2+ at 1 year, 3 years, 5 years and 10 years were 9.6%, 12.5%, 14.3% and 21.4%, respectively. Multivariate Cox regression analysis showed that suffering from high blood pressure［HR(95%CI)=1.70(1.18-2.44), P=0.004］, receiving simultaneous tricuspid valvuloplasty［HR(95%CI)=1.65(1.16-2.36), P=0.006］, larger preoperative left ventricular end-systolic diameter［HR(95%CI)=1.09(1.03-1.15), P=0.002］, larger left atrial diameter 1 week after operation［HR(95%CI)=1.03(1.01-1.06), P=0.031］ and high MR grading 1 week after operation［HR(95%CI)=59.63(21.84-162.82), P<0.001］ were risk factors for MR recurrence. The overall exemption rates of the patients for mitral valve reoperation at 1 year, 3 years, 5 years, and 10 years were 99.6%, 98.9%, 98.7% and 97.9%, respectively. Conclusion　TCMI-MVP is safe and effective in advanced valve centres using various repair techniques in a rational manner, and good long-term repair outcomes can be achieved.
Key words:  Mitral regurgitation(MR)  Total thoracoscopic minimally invasive  Mitral valvuloplasty(MVP)