急性Stanford A型主动脉夹层合并二尖瓣反流的外科治疗  

Surgical treatment of acute type A dissection with mitral regurgitation

作　　者：里程楠 朱俊明 齐瑞东 杨祎 于海 邢晓燕 陈苏伟 刘永民 孙立忠 Li Chengnai;Zhu Junming;Qi Ruidong;Yang Yi;Yu Hai;Xing Xiaoyan;Chen Suwei;Liu Yongmin;Sun Lizhong(Beijing Aortic Disease Center,Beijing Institute of Heart,Lung and Blood Vessel Diseases&Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心脏外科中心北京市主动脉疾病诊疗中心,100029

出　　处：《中华胸心血管外科杂志》2020年第8期478-480,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家科技支撑计划项目(2015BA112B03);北京市科技重大专项课题(Z171100001017083)。

摘　　要：目的急性Stanford A型主动脉夹层合并二尖瓣反流罕见,总结急性Stanford A型主动脉夹层合并二尖瓣反流的外科治疗经验.方法2010年10月至2017年1月,17例急性Stanford A型主动脉夹层合并二尖瓣反流患者接受外科手术治疗.男12例,女5例;年龄(38±11)岁.术前合并高血压9例,马方综合征2例,肾功能不全3例,心功能不全3例,扩张型心肌病1例;下肢缺血2例,1例腹主动脉替换术史.结果同期手术包括:Bentall术16例,弓部替换15例,三尖瓣成形术3例,冠状动脉旁路移植术2例,升主动脉-股动脉转流1例.院内死亡3例(17.6%,3/17).呼吸机辅助时间24 h以内11例,48 h以内3例,超过48h3例,分别为89、92、136 h.术后持续血液滤过3例,二次开胸止血1例,心包开窗1例.随访期间,1例患者失访,其余患者无死亡,恢复良好.结论急性Stanford A型主动脉夹层合并二尖瓣反流非常少见,外科手术风险大,死亡比例较高、并发症较多.积极及时外科手术,积极有效行心脏和脑保护,得到可接受的临床疗效.Objective Acute type A dissection with mitral regurgitation was very rare.To sum up our experience of surgical treatment of acute type A dissection with mitral regurgitation.Methods From October 2010 to January 2017,17 patients with acute Lype A dissection with mitral regurgitation undenvent surgical treatment.There were 12 males,5 females;mean age,(38±11)years(range,18-59 years).Hypertension was noted in 9 patients,Marfan syndrome in 2 patients,renal dysfuc-tion in 3 patients,cardiac dysfunction in 3 patients,lower limb ischemia was observed in 2 patients and dilated cardiomyopathy in one patient.Preoperative abdominal aortic replacement was observed in one case.Results Concomitant procedures included Bentall procedure in 16 patients,aortic arch operation in 15 patients,tricuspid valve plasLy in 3 patients,coronary artery bypass grafting in 2 patients and asceding aorta-femoral artery bypass in one patient.11 patients required mechanical ventilation for<24 hours,3 cases for<48 hours and 3 subjects for>48 hours.Continuous renal replacement therapy was required in 3 patients,re-operation in one patient and partial pericardial excision in one patient.One patient、vas out of follow-up.The remaining had a normal life during follow-up.Conclusion Repair of acute type A dissection with mitral regurgitation carried with a relatively high mortality and morbidiLy.Under better protection of heart and cerebrum,it obtained accepted surgical results in patients with this lesion.

关 键 词：急性Stanford A型主动脉夹层 二尖瓣反流 外科治疗 孙氏手术 二尖瓣矫治术 

分 类 号：R654.2[医药卫生—外科学]