Stanford A型主动脉夹层术中单纯连续缝合法与经典三明治缝合法用于吻合主动脉根部断端对比观察  

Comparative analysis of simple continuous suture and classic sandwich technique in anastomosis of aortic root in Stanford type A aortic dissection

作　　者：李子昂 雷印胜 王明华 郑晓舟 苗强 LI Ziang;LEI Yinsheng;WANG Minghua;ZHENG Xiaozhou;MIAO Qiang(The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China)

机构地区：[1]山东第一医科大学第一附属医院,山东济南250014

出　　处：《山东医药》2020年第33期14-18,共5页Shandong Medical Journal

摘　　要：目的观察Stanford A型主动脉夹层术中单纯连续缝合法与经典三明治缝合法用于吻合主动脉根部断端的效果,并进行比较。方法Stanford A型主动脉夹层患者32例,分为单纯连续缝合组(16例)、经典三明治缝合组(16例)。单纯连续缝合组患者在Stanford A型主动脉夹层术中使用单纯连续缝合吻合主动脉根部断端,经典三明治缝合组患者在Stanford A型主动脉夹层术中使用经典三明治缝合吻合主动脉根部断端。观察并记录两组患者手术时间、体外循环时间、主动脉阻断时间、并行辅助时间、首个24小时胸腔引流量、术后呼吸机辅助通气时间、ICU停留时间等手术相关指标;观察并记录两组患者手术前、手术后的左室射血分数、主动脉窦部直径、升主动脉内径等心脏超声指标。观察并记录两组患者肺部感染、胸腔积液、截瘫、呼吸功能不全等术后并发症情况。结果两组患者均手术成功。单纯连续缝合组手术时间、体外循环时间、主动脉阻断时间、并行辅助时间、术后呼吸机辅助通气时间均低于经典三明治缝合组(P均<0.05)。两组手术后窦部直径、升主动脉内径均低于手术前(P均<0.05);两组间手术前和手术后左室射血分数、窦部直径、升主动脉内径差异无统计学意义(P均>0.05)。单纯连续缝合组术后并发症例数低于经典三明治缝合组(P<0.05)。结论单纯连续缝合与经典三明治缝合均是Stanford A型主动脉夹层术中主动脉根部断端吻合的安全方式,能有效缩小窦部直径及升主动脉内径;单纯连续缝合较经典三明治缝合手术时间更短、并发症更少、术后恢复更快。Objective To observe and compare the therapeutic effects of simple continuous suture and classic sandwich technique in the anastomosis of the aortic root in Stanford type A aortic dissection.Methods According to different end-to-end anastomotic methods,32 patients with Stanford type A aortic dissection were divided into two groups.In the group of using simple continuous suture,the artificial graft was anastomosed with the aortic wall continuously.In the group of using classic sandwich technique,the classic sandwich technique was used to strengthen both the inner and outer layers of the aortic wall.The operation-related indexes of each group,including the operation time,cardiopulmonary bypass time,aortic occlusion time and parallel auxiliary time,the first 24-hour thoracic drainage volume,postoperative ventilator-assisted ventilation time,and ICU stay time,were observed and recorded.Echocardiographic parameters of each group,including the left ventricular ejection fraction,aortic sinus diameter and ascending aorta diameter,were observed and recorded before and after operation.The postoperative complications of each group,such as pulmonary infection,pleural effusion,paraplegia and respiratory insufficiency,were observed and recorded.Results The operation was successful in both groups.The operation time,cardiopulmonary bypass time,aortic occlusion time,parallel assisted time and postoperative ventilator assisted ventilation time of the group using simple continuous suture were significantly shorter than those of the group using classic sandwich technique(all P<0.05).The diameter of aortic sinus and ascending aorta after operation was smaller than that before operation in both groups(both P<0.05).There was no significant difference in the left ventricular ejection fraction,aortic sinus diameter or ascending aorta diameter after operation as compared with that before operation between two groups(P>0.05).The number of postoperative complications in the simple continuous suture group was smaller than that in the classic

关 键 词：单纯连续缝合法 经典三明治缝合法 主动脉夹层 主动脉根部断端吻合 

分 类 号：R543.1[医药卫生—心血管疾病]