经胸骨上段小切口David术在A型主动脉夹层患者中的应用  

Aortic valve-sparing operation through upper hemisternotomy in type A aortic dissection

作　　者：董兆芮 李东[3] 陈磊[2] 吴扬[3] 任崇雷[2] 汪成[2] 陈婷婷[2] 周琪[2] 杨瑞冬[2] 肖苍松[2] Dong Zhaorui;Li Dong;Chen Lei;Wu Yang;Ren Chonglei;Wang Cheng;Chen Tingting;Zhou Qi;Yang Ruidong;Xiao Cangsong(Department of Cardiovascular Surgery,the Sixth Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第六医学中心心血管外科,北京100853 [3]解放军总医院第一医学中心心脏大血管外科,北京100853

出　　处：《中国体外循环杂志》2022年第5期295-298,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 总结经胸骨上段小切口保留主动脉瓣的主动脉根部置换术(David手术)在A型主动脉夹层(TAAD)患者中的应用,观察临床疗效。方法 回顾性分析2017年至2020年本科收治的7例TAAD患者行经胸骨上段小切口David手术的临床资料。其中男性6例(85.7%),女性1例,年龄(27~55)岁。术前超声测定主动脉瓣中度返流2例,重度5例。术式包括:均经胸骨上段小切口完成手术,其中急诊David+升主、全弓置换+降主动脉支架植入6例,二次开胸David+升主、全弓置换+降主动脉支架植入1例。结果 全部7例手术均顺利完成,术后未发生严重并发症,均顺利康复出院,无30天内死亡。术中体外循环时间(268.0±43.7)min,主动脉阻断时间(209.1±23.8)min,低温停循环时间(36.0±8.7)min。术中最低膀胱温(27.2±2.0)℃。术后患者主动脉瓣无返流5例,轻度返流2例。术后随访(34.7±14.4)月,随访期间无患者需再次手术。结论 对TAAD合并主动脉瓣返流的年轻患者,可采用经胸骨上段小切口David手术处理主动脉根部,其近中期主动脉瓣膜功能良好,可提高患者生活质量。Objective To summarize aortic valve-sparing operation(David procedure) through upper hemisternotomy in patients with type A aortic dissection(TAAD).Methods We retrospectively analyzed the clinical data of 7 patients with TAAD in our department from 2017 to 2020 who underwent David procedure through upper hemisternotomy.There were 6 males(85.7%) and 1 female patient.The age was 27-55(43.9±11.6) years old.Preoperative echocardiography showed that there were 2 cases of moderate regurgitation and 5 cases of severe regurgitation.The surgical procedures of these cases included:Emergency David + ascending main and total arch replacement + descending aortic stent implantation through upper hemisternotomy in 6 cases,Redo David + ascending main and total arch replacement + descending aortic stent implantation through upper hemisternotomy in 1 case.Results All 7 operations were successfully completed,the patients had no serious complications,recovered and discharged smoothly,and there was no death within 30 days.Intraoperative cardiopulmonary bypass time was 268.0±43.7 min,aortic cross-clamping time was 209.1±23.8 min,and hypothermic circulatory arrest time was 36.0±8.7 min.The minimum intraoperative bladder temperature was 27.2±2.0℃.Among the 7 patients,5 cases had no aortic regurgitation and 2 cases had mild regurgitation.The postoperative follow-up was 34.7±14.4 months,and no patient needed reoperation during the follow-up period.Conclusion We found that in young patients with TAAD and aortic regurgitation,aortic root replacement with aortic valve preservation(modified David operation through upper hemisternotomy) can be preferred.The valve function in the early and medium-term after the operation is good,which can improve the life quality of patients.

关 键 词：胸骨上段切口 主动脉夹层 主动脉瓣关闭不全 David术 

分 类 号：R654.3[医药卫生—外科学]