再次主动脉手术的重要病因——结缔组织病  

Connective tissue disease: an important cause of reoperation of aorta

作　　者：李畑波 刘宸铖 徐博 王咏[1] 肖颖彬[1] LI Tianbo;LIU Chencheng;XU Bo;WANG Yong;XIAO Yingbin(Department of Cardiovascular Surgery,PLA Institute of Cardiovascular Surgery,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)

机构地区：[1]陆军军医大学(第三军医大学)新桥医院心血管外科,全军心血管外科研究所,重庆400037

出　　处：《第三军医大学学报》2021年第22期2449-2454,共6页Journal of Third Military Medical University

基　　金：陆军军医大学临床技术创新培育项目(CX2019JS216)。

摘　　要：目的探讨以结缔组织病为病因的再次主动脉手术的临床特点和外科治疗经验。方法回顾性分析2010年1月至2019年12月我科完成的45例再次主动脉手术患者的围手术期及随访资料。其中男性33例,女性12例,年龄9~73(46.0±14.1)岁。结缔组织疾病19例,包括白塞氏病9例、马凡氏综合征4例、主动脉瓣二叶畸形6例。再次行Bentall手术24例、Bentall+全主动脉弓置换术+降主动脉支架象鼻手术6例、Bentall+二尖瓣置换术5例、其他手术类型10例,术后连续随访17~113(58.5±25.6)个月。结果再次主动脉手术较为少见,仅占我科同期再次心血管外科手术的7.3%(45/617),而结缔组织病占其中的42.2%(19/45)。围手术期死亡5例,其中2例心脏骤停、2例持续性低心排综合征、1例顽固性低氧血症。随访过程中死亡7例,其中白塞氏病4例,马凡氏综合征1例,主动脉夹层术后2例;其余病例手术效果满意。Kaplan-Meier生存分析结果显示:随访期间白塞氏病死亡率最高(Log-rank检验,P=0.0082)。结论结缔组织病为再次主动脉手术的重要病因,其中白塞氏病术后死亡率最高、预后最差。Objective To investigate the clinical characteristics and surgical treatment experience of reoperation of aorta caused by connective tissue disease.Methods The perioperative and follow-up data of 45 patients with reoperation of aorta in our department from January 2010 to December 2019 were collected and retrospectively analyzed.They were 33 males and 12 females,at an age from 9 ~ 73(46.0±14.1) years.There were 19 cases of connective tissue disease,including 9 cases of Behcet ’s disease,4 cases of Marfan ’s syndrome and 6 cases of bicuspid aortic valve.Bentall operation was performed in 24 cases,Bentall + total aortic arch replacement + descending aortic stent elephant trunk operation in 6 cases,Bentall + mitral valve replacement in 5 cases,and other types of operation in 10 cases.All the patients were followed up for 17 ~ 113(58.5±25.6) months.Results Reoperation of aorta was quite rare,only accounting for 7.3% of reoperation of cardiovascular surgeries in our department(45/617),while connective tissue disease took 42.2%(19/45)among the reoperation.There were 5 patients who died during perioperative period,including 2 cases due to cardiac arrest,2 cases to persistent low cardiac output syndrome and 1 case to refractory hypoxemia.During the follow-up,7 cases died,including 4 cases due to Behcet’s disease,1 case to Marfan’s syndrome and 2 cases to aortic dissection.The outcomes of other cases were satisfactory.Kaplan-Meier survival analysis indicated the mortality rate of Behect’s disease was the highest during follow-up period(Log rank test,P = 0.0082).Conclusion Connective tissue disease is an important cause of aortic reoperation.Behcet’s disease has the highest mortality and the worst prognosis.

关 键 词：心血管外科手术 再次主动脉手术 结缔组织病 白塞氏病 

分 类 号：R181.32[医药卫生—流行病学] R619[医药卫生—公共卫生与预防医学]