2022 年第 9 期 第 17 卷

瓣膜成形术是风湿性二尖瓣病变的首选治疗——摒弃陈旧的“置换”惯性思维谋略患者最佳生存

Surgical valvuloplasty is the first choice for the treatment of rheumatic mitral valve disease—abandoning the old "replacement" habitual thinking and planning the best survival for patients

作者：孟旭 罗天戈

英文作者：Meng Xu Luo Tiange

单位：首都医科大学附属北京安贞医院瓣膜外科中心，北京100029

英文单位：Valve Surgery Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：风湿性二尖瓣成形术；瓣膜修复术；瓣膜置换术；心脏功能

英文关键词：Rheumaticmitralvalvuloplasty;Valverepair;Valvereplacement;Cardiacfunction

• 摘要：

• 风湿性心脏瓣膜病作为瓣膜外科的高发疾病，选择合理的外科治疗方式至关重要。由于瓣膜成形术（也称瓣膜修复术）可以完整保留二尖瓣装置结构，因此相较于瓣膜置换术在术后能更好地维护心功能。风湿热感染作为与年龄相关的自限性疾病，并不会影响成形手术的预后。临床循证医学研究已经证实了风湿性二尖瓣成形术是优于瓣膜置换的治疗方式。同时，由于国情的不同，机械地照搬欧美的瓣膜外科指南并不符合我国的实际情况。我们团队所提出的标准化风湿成形术式，极大促进了该项技术的推广和普及。但是作为掌握一项外科技术的客观规律，仍然要完成一定的学习曲线。那种在不愿付出任何努力的前提下，就以偏概全地否定风湿性二尖瓣成形术的观念，才是目前制约我国风湿性心脏瓣膜病外科治疗技术发展及让患者获益的最大羁绊。

• Rheumatic valvular heart disease is a common disease in valvular surgery, and it is very important to choose reasonable surgical treatment. Due to the complete preservation of the mitral valve structure, valvuloplasty (valve repair) can better maintain cardiac function than valve replacement. Rheumatic fever infection, as an age-related self-limited disease, does not affect the prognosis of valvuloplasty. Clinical evidence-based studies have demonstrated that rheumatic mitral valvuloplasty is superior to valve replacement. At the same time, due to the different national conditions, mechanical copy of European and American valve surgery guidelines is not in line with the actual situation of China. The standardization of rheumatic mitral valvuloplasty proposed by the author′s team has greatly promoted the popularization and popularity of this technique. However, as an objective rule of mastering a surgical technique, there is still a certain learning curve to complete. That in the premise of not willing to pay any efforts, on the partial with the concept of rheumatic mitral valvuloplasty, is currently the biggest fetters that restricts the development of surgical treatment technology for rheumatic mitral valvuloplasty in our country and benefits patients.