David手术治疗主动脉根部疾患  

Valve-sparing aortic root replacement in patients with aortic root disease

作　　者：李巅远[1] 孙立忠[1] 田良鑫[1] 常谦[1] 朱俊明[1] 姜睿[1] 孟强[1] 陶天富[1] 刘宁宁[1] 陈兴彭[1] 

机构地区：[1]中国医学科学院阜外心血管病医院心外科,北京100037

出　　处：《中华医学杂志》2005年第42期2985-2987,共3页National Medical Journal of China

摘　　要：目的总结David手术的临床应用经验.方法 1998-2004年对29例患者行David手术,其中男20例,女9例;年龄10～64岁,平均39岁±17岁;术前心功能Ⅰ级10例,Ⅱ级15例,Ⅲ级4例;术前主动脉瓣反流轻度15例,中度9例,重度5例;手术行David Ⅰ型1例,David Ⅱ型25例,我们设计改良David手术3例.结果患者无手术死亡及近期死亡.体外循环时间126 min±25 min,心肌阻断时间87 min±22 min.术后随访时间29个月±15个月(5～74个月),术后所有患者心功能Ⅰ级.术后主动脉瓣无反流11例,轻度反流8例,中度反流2例.无患者需二次手术治疗. 结论保留主动脉瓣的主动脉根部替换术(David手术)对主动脉瓣叶及瓣环大致正常的主动脉根部瘤是一种较为理想的手术方案,近期效果满意,长期效果有待观察.Objective To review the results of the valve-sparing operation （David procedure） in patients with aortic root disease. Methods Twenty-nine patients with aortic root disease, 20 males and 9 females, aged 39 ± 17 （ 10 - 64） , 10 being of heart functional class Ⅰ , 15 of class Ⅱ , and 4 of class Ⅲ, and 15 with gentle, 9 with moderate, and 5 with severe aortic insufficiency underwent David procedure, one undergoing the aortic valve-sparing reimplantation （David Ⅰ）, 25 undergoing aortic valve-sparing remodeling （ David Ⅱ ）, and 3 undergoing a new modified aortic valve-sparing operation. After the operation the patients were followed up for 29 ± 15 months（5 -74 months）. Results No intra-operative death was found. The mean extracorporeal circulation time was 126 min ± 25 min, and the aortic crossclamp time was 87 rain ± 22 rain. All patients recovered to heart functional class Ⅰ . Post-operatively 11 patients showed no normal, eight gently and two moderate aortic regurgitation. Conclusion The valve-sparing operation is an ideal operation to the aortic root aneurysm with more or less normal aortic leaflets and valvular ring normal.

关 键 词：主动脉瓣关闭不全 主动脉瘤 保留主动脉瓣的主动脉替换术 

分 类 号：R654.2[医药卫生—外科学]