外膜内翻技术在急性A型主动脉夹层根部修复的短期及中远期效果  

Short-and mid-term results after adventitial inversion technique for root repair in acute type A aortic dissection

作　　者：范舒雅 丘俊涛 戴路 赵锐[1] 邱家伟 郭宏伟[1] 于存涛[1] Fan Shuya;Qiu Juntao;Dai Lu;Zhao Rui;Qiu Jiawei;Guo Hongwei;Yu Cuntao(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,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》2022年第5期266-271,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2016-12M-1-016)。

摘　　要：目的评估外膜内翻技术在急性A型主动脉夹层(acute type A aortic dissection,ATAAD)根部修复的安全性和有效性。方法回顾性收集2015年至2018年间490例同期收治的ATAAD患者临床资料。纳入标准为夹层累及窦管交界以下;接受开放手术治疗。排除标准为既往行根部处理;外伤致主动脉夹层;行根部置换术(Bentall或Daivd术式)。纳入490例,其中男366例(74.69%),女124例(25.31%);年龄24~77岁,平均(51.28±10.99)岁。利用方差检验/非参数检验以及卡方检验对患者资料进行分析,远期生存及二次干预情况以Kaplan-Meier曲线展示。结果所有患者按根部修复技术分为外膜内翻(A组)、直接缝合(B组)和包裹分流(C组)3组,术前A组平均年龄较高(53.05±11.09)岁,C组心功能较低,更多见肾灌注不良。术中A组平均HCA、CPB及ACC时长最短,平均最低肛温最高。3组围术期常见并发症发生率、病死率及随访生存和再干预率差异无统计学意义,A、B两组患者中远期随访均未进行根部非计划干预,A组根部直径形态及大小在随访过程中更稳定,3组根部直径分别为(33.14±3.74)mm、(34.51±3.83)mm和(33.89±3.89)mm(P=0.008)。结论外膜内翻技术应用于ATAAD患者根部修复安全有效,可达到满意的近远期效果。Objective To evaluate the safety and effectiveness of adventitial inversion technique for root repair in patients with acute type A aortic dissection(ATAAD).Methods Between 2015 and 2018,ATAAD patients with dissected root and underwent open surgery were included.The exclusion criteria were as follows:previous root intervention,traumatic dissection and patient underwent root replacement(Bentall or David procedure).490 ATAAD patients were included,366(74.69%)male and 124(25.31%)female,aged(51.28±10.99)years(range 24-77 years).The clinical data were retrospectively analyzed with ANOVA/nonparametric test and Chi-square test.Follow-up mortality and reoperation were displayed with Kaplan-Meier curve.Results All patients were technically divided into three groups:adventitial inversion(A),direct suture(B)and Cabrol-shunt(C).The mean age in group A was(53.05±11.09)years,whereas worse cardiac and renal function occurred in group C.The mean duration of HCA,CPB and ACC were shortest,with a highest average of minimum rectal temperature during surgical interval in group A.Postoperative complications and early mortality were similar among groups.There were no significant differences of mid-term mortality and reoperation among these three techniques.Though no late reintervention for aortic root was found in both group A and B,the root diameter was more stable in group A during follow-up period[(33.14±3.74)mm vs.(34.51±3.83)mm vs.(33.89±3.89)mm,P=0.008].Conclusion Adventitial inversion technique is safe and effective for root repair in patients with ATAAD,achieving satisfactory short-and mid-term effects.

关 键 词：外膜内翻 主动脉根部修复 主动脉夹层 分流包裹 

分 类 号：R654.3[医药卫生—外科学]