白塞病患者主动脉瓣关闭不全的外科治疗策略  

Surgical strategy for aortic regurgitation attributable to Behcet disease

作　　者：吴锡阶[1] 卢琳[1] 严亮亮[1] 李虔桢[1] 陈良万[1] Wu Xijie; Lu Lin; Yah Liangliang; Li Qianzhen; Chen Liangwan(Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China)

机构地区：[1]福建医科大学附属协和医院心脏外科,福州350001

出　　处：《中华胸心血管外科杂志》2018年第10期589-592,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨白塞病患者主动脉瓣关闭不全的外科治疗方法。方法回顾性分析18例白塞氏病患者并发主动脉瓣关闭不全行外科手术治疗的随访结果，总结不同外科手术方法的治疗效果。结果6例患者反复多次行单纯主动脉瓣机械瓣置换手术，术后仅1例生存，病死率83％。5例患者为第1次行主动脉机械瓣置换术后并发严重瓣周漏的患者，第2次行改良的Bentall手术（带瓣管道左心室流出道置人手术），术后2例死亡，病死率40％，其中1例术后7个月并发右冠吻合口的假性动脉瘤行再次手术并发低心排血量综合征死亡，1例术后11个月并发严重的瓣周漏再次手术并发低心排血量综合征死亡。7例行心包裙边带瓣管道左心室流出道置人手术，术后1例死亡，病死率14．3％，该患者术后第15个月并发严重的瓣周漏再次手术并发低心排血量综合征死亡。结论白塞病患者并发严重的主动脉瓣关闭不全行心包裙边带瓣管道左心室流出道置入手术可以有效防治术后瓣周漏并发症的发生，降低病死率。Objective To investigate the surgical strategy for aortic regurgitation attributable to Behcet disease. Methods The follow-up results of 18 patients with aortic regurgitation attributable to Behcet disease were retrospectively analyzed and the surgical effects of different surgical methods were summarized. Results 6 cases underwent isolate aortic valve replacement several times, one case was survial, the motality was 83 percent. 5 cases with severe paravalvular leakage after initial aortic valve replacement underwent the modified Bentall procedure, in which the valved conduit was proximally attached to the left ventricular outflow tract. In these patients one case underwent re-do operation because of the right coronary pseudoaneurysm and died of the low cardica output in postoperative 7 months. One case underwent re-do operation because of the prosthetic detach- ment and died of the low cardiac output in postoperative 11 months, the motality was 40 percent. 7 cases underwent the modi- fied Bentall procedure using the pericardium skirt below the valve sewing ring, one case underwent the re-do operation because of the prosthetic detachment and died of the low cardiac output in postoperative 15 months. The mortality was 14.3 percent. Conclusion The modified Bentall procedure with the valved conduit using the pericardium skirt below the valve sewing ring could prevent the prosthetic detachment and paravalvular leakage effectively.

关 键 词：白塞综合征 主动脉瓣关闭不全 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]