改良Bentall手术中应用残余瘤壁根部包裹技术的近期疗效  

Short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure

作　　者：蒙茂龙 王尧 卢平凡 李华鹏 任荣 张文 陈枫杰 庄贤勉 王湘 李刚 郭宏伟[2] MENG Maolong;WANG Yao;LU Pingfan;LI Huapeng;REN Rong;ZHANG Wen;CHEN Fengjie;ZHUANG Xianmian;WANG Xiang;LI Gang;GUO Hongwei(Department of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen,518057,Guangdong,P.R.China;Department of Vascular Surgery,National Center for Cardiovascular Disease and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院,阜外医院,深圳医院血管外科中心,广东深圳518057 [2]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：《中国胸心血管外科临床杂志》2024年第2期283-287,共5页Chinese Journal of Clinical 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：目的评价改良Bentall手术中应用残余瘤壁根部包裹技术的近期疗效。方法回顾性分析2021年3月—2022年3月于中国医学科学院阜外医院深圳医院行改良Bentall手术患者的临床资料。所有患者加用残余瘤壁袖状包裹根部,以预防、减少术中和术后出血、渗血。收集该技术的手术结果,包括体外循环时间、主动脉阻断时间、机械通气时间、住ICU时间、术后住院时间、术后第1 d胸腔引流量、左心室射血分数、左心室舒张末期内径及随访结果。结果纳入14例患者,其中男12例(85.71%)、女2例(14.29%),年龄(55.33±10.57)岁。无围术期死亡,体外循环时间(147.90±21.29)min,主动脉阻断时间(115.70±15.23)min,呼吸机辅助时间(19.42±8.98)h,住ICU时间(99.08±49.42)h,术后住院时间(16.33±2.74)d,术后第1 d胸腔引流量(333.33±91.98)mL,只有2例患者需要输血(分别为4.5 U、2 U)。随访(6.17±3.69)个月,无死亡,无主动脉及主动脉瓣相关并发症。术后出院前左心室舒张末期内径较术前明显缩小(P<0.001);术后半年左心室舒张末期内径较术后出院前明显缩小(P<0.001)。术后出院前射血分数较术前有轻微下降,但差异无统计学意义(P=0.219);术后半年左心室射血分数与术前差异无统计学意义(P=1.000)。结论改良Bentall手术应用残余瘤壁袖状包裹技术安全、有效,近期结果良好,可有效预防和减少根部渗血和小的出血。Objective To evaluate the short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure.Methods The patients undergoing modified Bentall procedure with the remnant aortic wall as a sleeve to cover the sewing area of composite valved graft and the aortic annulus for proximal hemostasis between March 2021 and March 2022 in Shenzhen Fuwai Hospital were enrolled.Short-term results were assessed by cardiopulmonary bypass time,aortic clamping time,mechanical ventilation time,ICU stay,postoperative hospital stay,effusion drainage on the first postoperative day,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),and follow-up results.Results A total of 14 patients were collected,including 12 males and 2 females,with a mean age of 55.33±10.57 years.There was no postoperative or follow-up death.Cardiopulmonary bypass time was 147.90±21.29 min,aortic clamping time was 115.70±15.23 min,mechanical ventilation time was 19.42±8.98 h,ICU stay was 99.08±49.42 h,and postoperative hospital stay was 16.33±2.74 d.Thoracic drainage volume was 333.33±91.98 mL on the first postoperative day.Only 2 patients required blood transfusion(4.5 U and 2 U,respectively).During the follow-up of 6.17±3.69 months,there was no death,no aortic or valve-related complications.There was statistical difference in the LVEDD between preoperation and before discharge after surgery(P<0.001),and between half a year after surgery and before discharge after surgery(P<0.001).There was a little decrease of LVEF before discharge after surgery compared with preoperative LVEF,but there was no statistical difference(P=0.219).There was no statistical difference in the LVEF half a year after operation compared with that before operation(P=1.000).Conclusion Sleeve wrapping technique using remnant aortic wall in modified Bentall procedure has good short-term results.This modification may be a simple,effective way in controlling proximal bleeding.

关 键 词：外科手术 止血 改良Bentall手术 

分 类 号：R654.2[医药卫生—外科学]