摘要
目的比较传统正中开胸手术和胸骨上段小切口治疗急性Stanford A型主动脉夹层的安全性及临床疗效分析。方法回顾分析2014年1月至2018年12月共78例急性Stanford A型主动脉夹层患者信息,其中微创胸骨上段小切口(upper hemisternotomy,UHS)手术20例,传统正中开胸手术(full sternotomy,FS)58例,所有手术由同一术者完成。根据性别、年龄、体质量指数(BMI)、左心室射血分数(LVEF)、EuroSCOREⅡ评分、手术种类进行匹配,UHS组和FS组各18例入组,比较两组术前基线资料和围术期各项指标。结果纳入的全部78例中死亡3例(3.9%)。匹配后两组间基线资料和手术方式无差异(P>0.05),两组病例仅UHS组1例(2.8%)因感染性脑出血死亡。UHS组比FS组体外循环时间短[(202±41)min对(235±39)min,P=0.041],两组间主动脉阻断时间[(159±38)min对(158±59)min,P=0.918]和下半身停循环时间[(40±10)min对(50±20)min,P=0.081]差异无统计学意义,UHS组停循环时膀胱温显著高于FS组[(28.2±2.3)℃对(24.0±3.1)℃,P=0.001]。与FS组相比,UHS组术中输注红细胞少[(4.8±2.8)U对(7.2±3.9)U,P=0.038]、术后引流量少[(855±657)ml对(1510±703)ml,P=0.007]、呼吸机支持时间短(22 h对58 h,P=0.037)、心脏监护室滞留时间短[(4.6±2.7)天对(7.2±2.8)天,P=0.009]、术后住院时间短[(8.2±3.8)天对(18.4±3.8)天,P=0.001],但UHS组术后行心包穿刺发生率高[7(38%)对1(6%),P=0.041]。两组术后新发需透析的肾功能不全3例(8.3%)、神经系统病并发症5例(13.9%)、两组各有1例因出血再次开胸止血。结论经胸骨上段小切口手术治疗急性Stanford A型主动脉夹层安全可行,围术期总体疗效优于传统开胸手术。
Objective In comparison with full sternotomy,we explore the safety and clinical efficacy of upper hemisternotomy for Stanford A acute aortic dissection.Methods Retrospective analysis of 78 patients with Stanford type A acute aortic dissection from January 2014 to December 2018(20 patients underwent UHS invasive,58 patients underwent FS invasive).Based on variables including gender、age、BMI、LVEF、Euro SCOREⅡand type of surgery,two matched cohorts including 18 patients respectively were constructed:group UHS and group FS,the baseline data and perioperative indicators were analyzed.Results Operative mortality was 3.9%(3 of 78).The patients'baseline data were nearly balanced between the two groups after matching(P>0.05),only 1 case died of infectious cerebral hemorrhage in the FS group.The UHS group had a shorter cardiopulmonary bypass time than the FS group[(202±41)min vs.(235±39)min,P=0.041].There was no significant difference in aorta clamping time[(159±38)min vs.(158±59)min,P=0.918]and hypothermic circulatory arrest time[(40±10)min vs.(50±20)min,P=0.081]between the two groups.The bladder temperature in the UHS group was significantly higher than that in the FS group[(24.0±3.1)℃vs.(28.2±2.3)℃,P=0.001].Compared with the FS group,the UHS group had less red blood cell transfusion[(4.8±2.8)U vs.(7.2±3.9)U,P=0.038],less postoperative drainage[(855±657)ml vs.(1510±703)ml,P=0.007],shorter ventilation support time(22 h vs.58 h,P=0.037),shorter intensive care unit retention time[(4.6±2.7)days vs.(7.2±2.8)days,P=0.009],and shorter postoperative hospital stay time[(8.2±3.8)days vs.(18.4±3.8)days,P=0.001],but the incidence of pericardial puncture was higher in the UHS group[7(33%)vs.1(6%),P=0.041].3 cases had postoperative renal insufficiency(requires dialysis),5 cases(13.9%)had neurological complications,1 case received re-exploration in the two groups respectively.Conclusion The upper hemisternotomy approach is safe and feasible for Stanford A acute aortic dissection,with excellent early outcomes
作者
姜伟
肖苍松
吴扬
李东
陈磊
叶卫华
王刚
王加利
Jiang Wei;Xiao Cangsong;Wu Yang;Li Dong;Chen Lei;Ye Weihua;Wang Gang;Wang Jiali(Department of Cardiovascular Surgery,PLA General Hospital,Beijing 100853,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2020年第6期336-341,共6页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
急性A型主动脉夹层
微创手术
胸骨上段小切口
倾向评分匹配分析
Stanford A acute aortic dissection
Minimal access approaches
Upper hemisternotomy
Propensity score matching analysis
