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目的:总结32例Ebstein畸形经改良Carpentier法手术治疗的疗效与经验。方法:回顾性分析自2003年6月至2013年8月采取改良Carpentier法手术治疗的32例Ebstein畸形(儿童23例,成人9例)的临床资料,其中男性15例,女性17例;年龄1~60岁,体质量8.5~68 kg。手术方式为改良Carpentier法,先将所有有用瓣叶切下,纵向折叠房化右心室,将瓣叶顺时针转位缝合至新瓣环根部,同期矫治合并畸形。其中6例因右心室发育差,三尖瓣瓣环小,加行双向格林术。结果:1例患儿因术后早期心律失常并发持续性低氧血症而死亡,余均存活,顺利出院。其中1例术后出现Ⅲ°房室传导阻滞,3个月后回转窦性心律。存活31例均获随访,随访时间1~72个月,其中术后复查超声心动三尖瓣反流情况轻度21例,轻中度5例,中度5例,重度1例。结论:运用改良Carpentier法手术治疗Ebstein畸形,较好保留了右心室形态,三尖瓣整形好,术后心功能恢复良好,效果满意。
Objective: To summarize the curative effect and experience of 32 cases of Ebstein’s deformity treated by modified Carpentier method. Methods: The clinical data of 32 cases of Ebstein’s deformity (23 cases of children and 9 cases of adults) who underwent modified Carpentier operation from June 2003 to August 2013 were retrospectively analyzed. There were 15 males and 17 females, and the age was 1 ~ 60 years old, body weight 8.5 ~ 68 kg. Surgical methods for the improved Carpentier method, first all the useful leaflets cut, longitudinally folded atrial right ventricular, the valve leaflets clockwise suture to the new annulus root, the same period correction of malformations. 6 cases of poor development of the right ventricle, tricuspid annulus is small, plus two-way Green surgery. Results: One patient died of early postoperative arrhythmia complicated with persistent hypoxemia. All survived and were discharged smoothly. One case of postoperative Ⅲ ° atrioventricular block, 3 months after the sinus rhythm. Survival of 31 patients were followed up for 1 to 72 months. Among them, 21 cases were mild to moderate tricuspid regurgitation, 5 were mild to moderate, 5 were moderate and 1 were severe. Conclusion: The modified Carpentier method for the treatment of Ebstein’s deformity, better retained right ventricular morphology, tricuspid valve shaping good, good recovery of cardiac function, the effect is satisfactory.