主动脉根部袖状包裹技术在改良Bentall手术中应用的近期疗效  

Short-term outcomes of cuff wrapping technique using remnant aortic wall in modified bentall procedure

作　　者：范舒雅 畅怡[1] 郭宏伟[1] 魏柯 钱向阳[1] 孙晓刚[1] 于存涛[1] Fan Shuya;Chang Yi;Guo Hongwei;Wei Ke;Qian Xiangyang;Sun Xiaogang;Yu Cuntao(Department of Vascular Surgery,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院血管外科中心,北京100037

出　　处：《中华胸心血管外科杂志》2021年第9期550-552,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家心血管病中心阜外医院院所重点项目(2018-F02)。

摘　　要：目的评价主动脉根部袖状包裹技术在改良Bentall手术中应用的近期疗效。方法2018年1月至2018年12月,23例患者行改良Bentall手术,加用残余瘤壁袖状包裹主动脉根部,即袖状包裹技术,以预防和减少术中和术后出血、渗血。其中男21例(91.30%),女2例(8.70%);年龄22~72岁,平均(50.96±13.23)岁。收集患者术前一般资料、术中体外循环时间、主动脉阻断时间,术后呼吸机辅助时间、ICU时间、住院时间、术后第1天的胸腔引流量、手术前后左心室舒张期末内径、左心室射血分数以及出院后近期随访结果。结果全组无围手术期死亡。体外循环114~275 min,平均(157.74±39.85)min;主动脉阻断84~212 min,平均(122.61±30.25)min;术后呼吸机辅助7.87~20.33 h,平均(11.65±3.08)h;术后ICU时间15.18~184.77 h,平均(81.43±45.88)h;术后住院6~15天,平均(8.73±2.80)天。术后第1天胸腔引流量200~670 ml,平均(336.82±117.65)ml。随访19~30个月,平均(23.17±3.17)个月,无随访死亡,无主动脉及主动脉瓣相关并发症。患者左心室舒张期末内径出院前较术前明显缩小[(49.78±6.21)mm对(58.78±10.54)mm,P<0.05],随访期间较术后出院前缩小,但差异无统计学意义[(48.87±4.63)mm对(49.78±6.21)mm,P>0.05];左心室射血分数出院前较术前下降,但差异无统计学意义(0.57±0.07对0.59±0.05,P>0.05),随访期间较术前和出院前差异均有统计学意义(0.62±0.04对0.57±0.07,P<0.05)。结论主动脉根部残余瘤壁袖状包裹技术用于改良Bentall手术安全、有效,近期效果良好,可能会有效预防和减少根部渗血和小的出血。Objective To evaluate the short-term outcomes of cuff wrapping technique using remnant aortic wall in modified Bentall procedure.Methods Between January 2018 and December 2018,23 patients underwent modified Bentall procedure with the remnant aortic wall as a cuff to cover the sewing area of composite valved graft and the aortic annulus for proximal hemostasis.After the sewing ring of the composite valved graft was sutured to the aortic annulus by continuous suture,the remnant aortic wall was sutured to the graft just distal to the sewing ring by continuous suture.There were 21 males and 2 females,aged from 22 to 72 with a mean of(50.96±13.23)years.Short-term outcomes were assessed by cardiopulmonary bypass time,clamp aorta time,mechanical ventilation time,ICU time,postoperative stay time,effusion drainage till the first postoperative day,Left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),and follow-up results.Results There were no postoperative and follow-up death.Cardiopulmonary bypass time was(157.74±39.85)min,ranged from 114 to 275 min;clamp aorta time(122.61±30.25)min,ranged from 84 to 212 min;mechanical ventilation time(11.65±3.08)h,ranged from 7.87 to 20.33 h;ICU time(81.43±45.88)h,ranged from 15.18 to 184.77 h;postoperative stay time(8.73±2.80)days,ranged from 6 to 15 days.Effusion drainage was(336.82±117.65)ml,ranged from 200 to 670 ml till the first postoperative day.Follow-up was performed from 19 to 30 months,with a mean of(23.17±3.17)months.There were significant differences between preoperative LVEDD and postoperative LVEDD before discharge[(49.78±6.21)mm vs.(58.78±10.54)mm,P<0.05];There were a little decrease of follow-up LVEDD compared with postoperative LVEDD,but no significant difference between them[(48.87±4.63)mm vs.(49.78±6.21)mm,P>0.05].There were a little decrease of postoperative LVEF compared with preoperative LVEF,but no significant difference between them(0.57±0.07 vs.0.59±0.05,P>0.05).There were significant differences between follow-up

关 键 词：改良Bentall手术 外科 止血 

分 类 号：R654.2[医药卫生—外科学]