胸骨上段小切口主动脉根部置换术  

Upper Ministernotomy for Aortic Root Replacement

作　　者：孙立忠[1] 常谦[1] 唐跃[1] 冯钧[1] 孙晓刚[1] 朱晓东[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京市100037

出　　处：《中国循环杂志》2000年第4期204-205,共2页Chinese Circulation Journal

摘　　要：目的 :探讨胸骨上段小切口主动脉根部置换术的手术适应证、基本方法和手术技术。　　方法 :1999年 7月至 9月 ,对 8例马凡综合征主动脉根部瘤合并主动脉瓣关闭不全患者以复合带瓣人工血管行主动脉根部置换术。基本方法包括胸骨上窝至乳头连线水平纵切口 ,长约 10～ 13cm,“J”形纵劈上段部分胸骨 ,股动脉、右心房或股静脉插管体外循环。　　结果 :心肌阻断时间 5 8(5 4～ 6 7)分 ,体外循环时间 78(70～ 90 )分 ,总手术时间 4小时 15分 (3小时 2 0分～ 4小时 45分 ) ,术后住院时间 12 (9～ 2 5 )天 ,输血量 40 0 (0～ 16 0 0 ) ml,2例患者未输库血。全部患者康复出院。　　结论 :胸骨上段小切口行主动脉根部置换术 ,股动脉、右心房或股静脉插管体外循环 ,术野显露良好 ,创伤小 ,失血少 ,术后恢复快 ,是一种安全可靠的方法。Objective:The indication,manoeuvre and skill for aortic root replacement by the approach of upper ministernotomy were discussed. Methods:From July to September of 1999,8 patients diagnosed as Marfan's syndrome with aortic root aneurysm and aortic incompetence underwent aortic root replacement using composite valve grafts.An upper ministernotomy from the supersternal notch to the level of nipples was made with the 10—13 cm of skin incision.The cardiopulmonary bypass was established though cannulations of femoral artery and femoral vein,superior vena cava or right atrium. Results:Aortic clamp time was 58 min (54—67 min) and cardiopulmonary bypass time was 78 min(70—90 min).The average operative time was 4 hours and 15 min.The postoperative stay in hospital was 12 days (9—25 days).The amount of transfusion blood was 400 ml (0—1 600 ml).All patients were discharged eventually with complete recovery. Conclusion:Our experience demonstrated that aortic root replacement through the upper ministernotomy provides excellent exposure,less tramma and quick recovery,and is a safe and reliable method.

关 键 词：微创 主动脉根部置换术 胸骨上段小切口 

分 类 号：R654.2[医药卫生—外科学]