摘要
目的探讨在胸骨上段小切口下行保留主动脉瓣的主动脉根部替换术的早期效果。方法回顾性分析2016年4月至2020年4月在中国医学科学院阜外医院血管外科中心接受胸骨上段小切口下保留主动脉瓣的主动脉根部替换术(David手术)的31例患者的临床资料。男性28例,女性3例,年龄(44±13)岁(范围:11~65岁)。手术方式包括单纯David手术26例,David+升主动脉置换+部分主动脉弓人工血管置换3例,David+胸主动脉腔内修复术1例,David+支架象鼻植入术1例。收集患者围手术期资料及随访资料。结果患者均顺利完成手术。手术时间(330±58)min(范围:214~481 min),心肺转流时间(138±23)min(范围:106~192 min),主动脉阻断时间(108±17)min(范围:82~145 min)。无死亡及卒中、心肌梗死、肾功能不全、严重感染等严重并发症。术后24 h胸腔引流量(314±154)ml(范围:130~830 ml),呼吸机支持时间(14±3)h(范围:8~21 h),ICU停留时间[M(Q_(R))]2.1(1.5)d(范围:1.0~5.0 d)。8例患者无输血,红细胞输注比例为9.7%(3/31),血浆输注比例为22.6%(7/31),血小板输注比例为71.0%(22/31)。术后患者主动脉瓣反流改善明显,无中量及以上反流。随访3.5(6.1)个月(范围:2.0~39.0个月),26例获得超声心动图随访资料,主动脉瓣中量反流1例,少中量反流9例,少量反流5例,微量反流6例,无反流5例,随访期内均无主动脉瓣再次干预。结论胸骨上段小切口行保留主动脉瓣的主动脉根部替换术近期结果良好,中长期结果需进一步研究。
Objective To examine the early outcome of valve sparing aortic root replacement with reimplantation technique(David procedure)with partial upper sternotomy.Methods From April 2016 to April 2020,31 patients underwent valve sparing aortic root replacement under partial upper sternotomy at Vascular Surgery Center,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.There were 28 males and 3 females,aging(44±13)years(range:11 to 65 years).Preoperative aortic regurgitation was found greater than moderate in 15 patients,moderate in 6 patients and less than moderate in 10 patients.The diameter of aortic annulus was(26±3)mm(range:21 to 34 mm),the diameter of aortic sinus was(51±6)mm(range:41 to 68 mm),the diameter of ascending aorta was(43±8)mm(range:26 to 62 mm).The preoperative ejection fraction was(65±4)%(range:59%to 72%)and left ventricular end-diastolic diameter was(55±6)mm(range:42 to 68 mm).All cases were treated with DavidⅠprocedure,including simple David procedure in 26 patients,David+ascending aorta and partial aortic arch replacement in 3 patients,David+thoracic endovascular aortic repair in 1 patient,David+stent elephant trunk implantation in 1 patient.Results The operation time,cardiopulmonary bypass time and aortic cross-clamping time were(330±58)minutes(range:214 to 481 minutes),(138±23)minutes(range:106 to 192 minutes)and(108±17)minutes(range:82 to 154 minutes),respectively.There were no death and serious complications(stroke,myocardial infarction,renal insufficiency,severe infection,etc.).The postoperative drainage volume within 24 hours was(314±145)ml(range:130 to 830 ml).The intubation time was(14±3)hours(range:8 to 21 hours),and the ICU time was(M(Q_(R)))2.1(1.5)days(range:1.0 to 5.0 days).Eight patients had no blood transfusion,the proportion of red blood cell use was 9.7%(3/31),plasma use was 22.6%(7/31),and platelet use was 71.0%(22/31).The postoperative left ventricular ejection fraction was(62±4)%(range:54%to 69%),and left ventricular end-diastolic dia
作者
侯斌
王德
王维
赵振华
高伟
李方
杨贵博
孙晓刚
钱向阳
于存涛
Hou Bin;Wang De;Wang Wei;Zhao Zhenhua;Gao Wei;Li Fang;Yang Guibo;Sun Xiaogang;Qian Xiangyang;Yu Cuntao(Vascular Surgery Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,State Key Laboratory of Cardiovascular Disease,Beijing 100037,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2021年第10期861-866,共6页
Chinese Journal of Surgery
基金
中国医学科学院阜外医院特色学科发展专项基金(2015-FWTS01)。
关键词
主动脉瘤
胸
心脏外科手术
人工血管
Aortic aneurysm,thoracic
Cardiac surgical procedures
Blood vessel prosthesis
