保留主动脉瓣根部手术治疗马方综合征的近期疗效  

Short-term follow-up of valve-sparing aortic root replacement in Marfan syndrome

作　　者：郭静[1] 舒礼良[1] 黄功成 黄辰[1] 魏廷举 徐敬[1] 

机构地区：[1]郑州大学第一附属医院心血管外三科,450052

出　　处：《中华胸心血管外科杂志》2017年第12期721-724,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 评价保留主动脉瓣根部手术治疗马方综合征的近期疗效.方法 54例患者,男38例,女16例;年龄20～50岁,平均（31.26±7.80）岁.术前均根据1996年制定的Ghent标准确诊为马方综合征.术前超声心动图示主动脉瓣反流微量5例,少量12例,中量22例,大量15例.根据影像学资料及术中探查,决定是否保留主动脉瓣,其中行Bentall＋二尖瓣成形（MVP）手术2例,Bentall＋二尖瓣置换（MVR）手术4例,Bentall＋全弓＋象鼻手术2例,Bentall手术27例,David＋MVP手术6例,David手术13例.根据术式分为Bentall手术组35例和David手术组19例.随访12～48个月,比较两组手术前、后和不同方案的疗效差异.结果 手术死亡2例,Bentall手术组1例死于术后无法控制的大出血,,David手术组1例死于术后肺部感染、多脏器功能衰竭.52例恢复良好,术后心包及纵隔引流310～820 ml;住院11～29天,平均（16.43±4.38）天.Bentall手术组体外循环（141.09±15.48）min,主动脉阻断（93.82±15.06）min.David手术组体外循环（186.32±23.96）min,主动脉阻断（140.21±22.13）min.术后两种术式的射血分数、左心室径、左心室收缩期末容量、左心室舒张末期容量、短轴缩短率改善与术前相比差异有统计学意义（P〈0.05）,但组间差异无统计学意义（P〉0.05）,术后早期并发症发生比例组间差异无统计学意义,晚期并发症Bentall手术组明显高于David手术组.术后David手术组主动脉瓣反流程度较术前明显减轻（1.37±0.95对2.53±0.84,P〈0.05）.随访期间David手术组1例主动脉瓣重度关闭不全行主动脉瓣置换术;Bentall手术组1例再发腹主动脉夹层手术治疗,6例因华法林抗凝出现出血、栓塞并发症.结论 保留主动脉瓣的根部处理治疗马方综合征的近期疗效满意.Objective To evaluate the short-term follow-up of valve-sparing aortic root replacement in Marfan syndrome. Methods 54 patients, 38 males and 16 females;aged（20-50） years, mean（31. 26 ± 7. 80） years old. They were all diag-nosed with Marfan syndrome according to the criteria of Ghent in 1996. Preoperative ultrasound showed 5 cases with trace aortic valve regurgitation, a small amount of reflux in 12 cases, 22 cases in the middle amount of regurgitation, 15 cases with a large number of reflux. According to the surgery program it was devided into 2 groups, Bentall group（35 cases, Bentall surgery） and David group（19 cases, David surgery）. Follow-up 12 months to 48 months, to compare the differences of the efficacy of differ-ent surgical options,before and after surgery. Results 2 cases died after operation, one patient in group bentall died of uncon-trollable bleeding and the other in group David died of pulmonary infection, multiple organ failure, and the remaining 52 cases recoveredwell.GroupbentallwhichCPB（141.09±15.483）min,aorticocclusion（93.82±15.06）min. GroupDavid,CPB （186.32 ±23.96）min, aortic occlusion（140.21 ±22.13） min. There are significant differences in postoperative EF value, left ventricular diameter and postoperative left ventricular systolic volume （ ESV ） , postoperative left ventricular end-diastolic volume（EDV）, FS improvement with preoperative data（P〈0. 05）, and there were no significant differences（P〉0. 05） be-tween the two groups. The early postoperative complications were no significant difference between the tuo groups, bue the late complications in group bentall was significantly higher than groups David. Patients were followed up for 12 months to 48 months, one patient in David group underwent aortic valve replacement surgery because of severe aortic regurgitation. One case （ abdominal aorta） in group Bentall underwent surgery due to recurrent dissection and 6 cases with bleeding, embolic complica-tions because of warfarin. Concl

关 键 词：马凡综合征 心脏外科术 近期疗效 

分 类 号：R654.2[医药卫生—外科学]