根部加固联合人工血管内置间断吻合技术(XJ-Procedure)在急性A型主动脉夹层中的应用  

Aortic root reinforcement combined with vascular grafts built-in and intermittent anastomosis technique(XJ-procedure)for acute type A aortic dissection surgery

作　　者：李静[1] 赵长缨 郑幸龙[1] 张永健 钟亮 李勇新[1] 孙立忠 闫炀[1] Li Jing;Zhao Changying;Zheng Xinglong;Zhang Yongjian;Zhong Liang;Li Yongxin;Sun Lizhong;Yan Yang(Department of Cardiovascular Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiovascular Surgery Delta Health Hospital,Shanghai 201702,China)

机构地区：[1]西安交通大学第一附属医院心血管外科,西安710061 [2]首都医科大学附属北京安贞医院,北京100029 [3]上海德达医院心脏大血管外科,上海201702

出　　处：《中华胸心血管外科杂志》2024年第12期736-743,共8页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：陕西省重点研发项目,重点产业创新链(群)-社会发展领域(2022ZDLSF04-08)。

摘　　要：目的评估主动脉根部加固联合人工血管内置间断吻合技术(XJ-Procedure)在急性A型主动脉夹层根部修复的安全性和有效性。方法回顾性分析西安交通大学第一附属医院2020年1月至2022年6月期间行孙氏手术治疗的509例急性A型主动脉夹层患者。根据主动脉根部处理方式的不同,分为主动脉根部加固联合人工血管内置间断吻合技术(XJ-Procedure)组、连续吻合间断褥式加固组和Bentall组。比较3组患者围手术期资料及术后随访结果,分析XJ-Procedure在急性A型主动脉夹层根部处理中的疗效。结果本研究共纳入509例患者,其中XJ-Procedure组288例,连续吻合间断褥式加固组132例,Bentall组89例。全部患者30天死亡率为7.5%(38/509),XJ-Procedure组、连续吻合间断褥式加固组和Bentall组术后30天死亡率分别为7.3%,8.3%和6.7%。XJ-Procedure组手术时间355(320,380)min明显低于其余两组;体外循环时间[154(140,169)min]和主动脉阻断时间[80(72,89)]min低于Bentall组[166(147,184)min及86(77,96)min];术中无因根部出血再次转机干预的发生。术后早期相关并发症3组差异无统计学意义;出院前、术后3个月、6个月CTA随访发现XJ-Procedure组主动脉根部残留主动脉夹层发生率明显低于连续吻合间断褥式加固组(P<0.001)。结论"XJ-Procedure"根部修复技术是一种安全、操作简单、易掌握的急性A型主动脉夹层根部处理方法,临床早期疗效明显。Objective This study proposed a novel technique for aortic root reconstruction and evaluated its safety and effectiveness.MethodsAcute type A aortic dissection(ATAAD)patients who underwent Sun's procedure from January 2020 to June 2022 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively enrolled.These patients were divided into three groups according to their surgical procedures of aortic root:aortic root reinforcement combined with vascular grafts built-in and intermittent anastomosis technique(XJ-procedure)group,continuous suture and pledgeted interrupted reinforcement group and Bentall group.The perioperative data and postoperative follow-up results of the three groups were compared to analyze the efficacy of XJ-procedure in the root treatment of ATAAD.ResultsA total of 509 patients were enrolled in this study,including 288 patients in the XJ-procedure group,132 patients in the continuous suture and pledgeted interrupted reinforcement group and 89 patients in the Bentall group.The 30-day mortality of all patients was 7.5%(38/509),and were 7.3%,8.3%and 6.7%in the XJ-procedure group,continuous suture and pledgeted interrupted reinforcement group and Bentall group,respectively.The operation time of the XJ-procedure group[355(320,380)min]was significantly lower than the other two groups.The cardiopulmonary bypass time[154(140,169)min]and the aortic cross-clamping time[80(72,89)min]of XJ-procedure group were lower than the Bentall group[166(147,184)min and 86(77,96)min].The aortic root bleeding that required secondary cardiopulmonary bypass did not occur in the XJ-procedure group.There was no significant difference in early postoperative complications among the three groups.The incidence of residual aortic root dissection before discharge,in 3 and 6 months after operation was lower in the XJ-procedure group compared to the continuous suture and pledgeted interrupted reinforcement group(P<0.001).ConclusionThe XJ-procedure technique is a safe,simple and mastered method for the aortic ro

关 键 词：XJ-Procedure 主动脉根部修复 急性A型主动脉夹层 

分 类 号：R65[医药卫生—外科学]