主动脉根部修复术与置换术对Stanford A型主动脉夹层患者手术效果和术后并发症的影响  

Influence of aortic root repair and replacement on the surgical effect and postoperative complications of Stanford type A aortic dissection patients

作　　者：李传文[1] 孙庆燕[1] 甘延清 李宪卿[1] 蔡腾 刘宏生[1] 倪良春[1] Li Chuanwen;Sun Qingyan;Gan Yanqing;Li Xianqing;Cai Teng;Liu Hongsheng;Ni Liangchun(Department of Cardiac Surgery,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院心脏外科,济宁272029

出　　处：《国际外科学杂志》2025年第3期176-181,F0003,共7页International Journal of Surgery

基　　金：山东省自然科学基金面上项目(ZR2021MH346);济宁市重点研发计划项目任务书(2024YXNS004)。

摘　　要：目的:探讨主动脉根部修复术与置换术对Stanford A型主动脉夹层患者手术效果和术后并发症的影响。方法:采用回顾性病例对照的研究方法,选取2020年8月—2023年12月济宁医学院附属医院收治的190例Stanford A型主动脉夹层患者,根据手术治疗方式的不同将其分为修复组(n=65)和置换组(n=125)。修复组患者接受主动脉根部修复术,置换组患者接受主动脉根部替换术,即Bentall手术治疗。比较两组患者的手术相关指标、手术效果、术后结局及中期生存率。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验;非正态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用秩和检验。计数资料以例数和百分比(%)表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果:修复组和置换组患者远端主动脉操作情况、体外循环时间、低温停循环时间和阻断时间比较,差异均无统计学意义(P>0.05)。修复组和置换组患者呼吸机辅助时间、ICU入住时间、清醒后疼痛视觉模拟评分(VAS)及住院时间比较,差异均无统计学意义(P>0.05)。两组患者出院后30 d病死率(9.2%比11.2%)、术后并发症发生率(18.5%比22.4%)差异均无统计学意义(P>0.05)。Kaplan-Meier生存曲线分析结果显示,修复组和置换组患者中期生存率无关系(χ^(2)=0.46,P=0.500)。在随访期间,置换组有1例患者接受了再次手术,包括Bentall手术,间隔14个月。结论:主动脉根部修复术或置换术治疗对Stanford A型主动脉夹层患者的手术效果、术后并发症没有影响;主动脉根部修复术的近期、中期生存率与置换术相似,且在随访期间没有患者再次接受近端手术治疗,具有可行性和安全性。Objective:To investigate the effect of aortic root repair and replacement on the surgical effect and postoperative complications of Stanford type A aortic dissection.Methods:By retrospective case-control study,190 patients with Stanford type A aortic dissection admitted to the Affiliated Hospital of Jining Medical College from August 2020 to December 2023.According to the different surgical treatment methods,they were divided into repair group(n=65)and replacement group(n=125).Patients in the repair group received aortic root repair,while patients in the replacement group received aortic root replacement,that was,Bentall operation.The surgical related indexes,surgical effect,postoperative outcome and mid-term survival rate of the two groups were compared.The measurement data conforming to the normal distribution were expressed by the mean standard deviation(±s),and the comparison between groups adopted t-test;The measurement data of skewed distribution were expressed by M(Q_(1),Q_(3)),and the comparison between groups was conducted using the rank sum test.Counting data were expressed by the number of cases and percentage(%),and the comparison between groups was conducted by chi-square test or Fisher exact probability method.Results:There was no significant difference in distal aortic operation,cardiopulmonary bypass time,hypothermic circulatory arrest time and occlusion time between repair group and replacement group(P>0.05).There was no significant difference in ventilator-assisted time,intensive care unit stay time,visual analogue score(VAS)after waking up and hospitalization time between repair group and replacement group(P>0.05).There was no significant difference between the two groups in 30-days mortality rate after discharge(9.2%vs 11.2%)and postoperative complications(18.5%vs 22.4%)(P>0.05).Kaplan-Meier survival curve analysis showed that there was no significant relationship between the medium-term survival rate of patients in repair group and replacement group(χ^(2)=0.46,P=0.500).During the follow-up

关 键 词：肾肿瘤 肾积水 肾功能不全 图像重建 

分 类 号：R654.2[医药卫生—外科学]