部分主动脉根部重建术在急性Stanford A型主动脉夹层的应用  

The clinical results of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection

作　　者：李良鹏[1] 黄福华[1] 苏存华[1] 秦卫[1] 邱志兵[1] 蒋英硕[1] 汪黎明[1] 徐明[1] 陈鑫[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院南京市心血管病医院胸心血管外科,南京210006

出　　处：《中国胸心血管外科临床杂志》2017年第7期506-511,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金青年项目(81600225);江苏省自然科学基金青年项目(BK20160132);南京医科大学科技发展基金面上项目(2015NJMU045)

摘　　要：目的分析部分主动脉根部重建术在急性Stanford A型主动脉夹层的临床效果。方法 2010年1月至2015年12月,南京医科大学附属南京医院共30例急性A型主动脉夹层累及根部患者行手术治疗,其中男25例、女5例,年龄27~72(51.2±8.0)岁。夹层近心端施行了部分主动脉根部重建术:部分根部成形+升主动脉置换术9例,部分根部成形+升主动脉置换+半弓置换术6例,部分根部成形+升主动脉置换+孙氏手术15例。术后随访10~60(37.9±3.2)个月。比较术前、术后主动脉瓣反流程度等指标。结果全组中无手术死亡发生,1例患者术后15 d死于肺炎,生存率96.7%(29/30)。1例患者随访期间死亡,2例患者因主动脉瓣严重反流分别于术后1年和15个月再次入院行主动脉瓣置换术。截至最后一次随访,24例无主动脉瓣膜反流,2例少量反流。结论 Stanford A型主动脉夹层导致主动脉根部病变,部分主动脉根部重建术能够保留主动脉瓣瓣膜的持久性和功能性,可获得较满意的早、中期疗效。Objective To analyze the clinical effect of partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection. Methods From January 2010 to December 2015, 30 patients （25 males, 5 females） underwent partial aortic root remodeling for root reconstruction on Stanford type A aortic dissection with involvement of aortic root. The range of age was from 27 to 72 years, and the mean age was 51.2±8.0 years. The proximal aortic dissection received partial aortic root remodeling, and the operation procedures included partial aortic root remodeling＋ascending aortic replacement in 9 patients, partial aortic root remodeling＋ascending aortic replacement＋hemi-arch replacement in 6 patients, partial aortic root remodeling＋ascending aortic replacement＋Sun＇s procedure in 15 patients. The patients were followed up for 10 to 60 months with a mean of 37.9±3.2 months. Preoperative and postoperative degrees of aortic regurgitation were compared. Results All patients survived from the operation, and one patient died from severe pulmonary infection 15 days after operation. The overall survival rate was 96.7% （29/30）. One patient died during the follow-up. Two patients underwent aortic valve replacement in the 12th and 15th postoperative month respectively because of severe aortic regurgitation （AI）. Up to the last follow-up, trivial or no aortic regurgitation was demonstrated in 24 patients, but mild aortic regurgitation occurred in 2 patients. Conclusion The surgical treatment for aortic root pathology due to Stanford type A aortic dissection is challenging, and partial aortic root remodeling operations could restore valve durability and function, and obtains the early- and mid-term results.

关 键 词：部分主动脉根部重建术 主动脉夹层 主动脉瓣膜 

分 类 号：R654.3[医药卫生—外科学]