改良升主动脉近端成形在Stanford A型主动脉夹层手术中的应用

发布时间：2018-04-13 22:03

本文选题：主动脉夹层 + 吻合口出血　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：描述改良升主动脉近端成形的手术方法和技术要点，探讨此方法在StanfordA型主动脉夹层手术中应用的临床疗效。材料和方法：收集自2011年10月至2014年12月，于吉林大学第二医院心血管外科行Stanford A型主动脉夹层手术并于术中应用改良升主动脉近端成形方法的病例共153例。通过主动脉CTA、心脏彩超的检查结果，对患者术前、出院前、术后6个月随访的升主动脉近端直径、主动脉瓣反流量进行统计和对比分析；对比术前主动脉瓣中等量以上反流仅行升主动脉近端成形而未行主动脉瓣置换病例和行主动脉瓣置换病的术后效果；并统计患者的手术时间、体外循环时间、主动脉阻断时间、停循环时间、术中用血量、术后引流量、术后清醒时间、术后应用呼吸机时间、ICU停留时间、术后住院时间及有无术后大出血、二次开胸止血、近端夹层复发和假性动脉瘤形成等严重并发症，进行总结分析。结果：全组153例患者住院死亡9例，，痊愈出院144例，住院死亡率约为5.9%。全组无术中死亡，无术中行主动脉壁包埋及右心房引流处置，无难以控制的近端吻合口出血而二次转机止血，无术后二次开胸止血，术后无因大出血死亡，体外循环时间、主动脉阻断时间、停循环时间无明显延长，手术时间、术中用血减少，术后引流量较少。出院前133人复查主动脉CTA及心脏彩超，术后6个月102人复查主动脉CTA及心脏彩超，所有复查患者升主动脉近端直径及主动脉瓣反流量均为正常范围内，无近端夹层复发及假性动脉瘤形成。术前主动脉瓣反流仅行升主动脉近端成形而未行主动脉瓣置换病例术后及中期随访主动脉瓣反流量均在正常范围内，与主动脉瓣置换病例无明显差异。中期随访无出院后死亡，所有患者对生活质量满意。结论：改良升主动脉近端成形技术操作简单，可有效地加固主动脉断端，减少升主动脉近端吻合口出血的发生率，有效的减少近端夹层复发及假性动脉瘤形成等并发症的发生，对因夹层累及主动脉瓣交界而引起的主动脉瓣关闭不全有良好的治疗效果，在StanfordA型主动脉夹层的手术治疗中有较好的疗效，值得临床推广。
[Abstract]:Objective:This paper describes the operative methods and technical points of modified proximal ascending aorta plasty, and discusses the clinical effect of this method in StanfordA type aortic dissection.Materials and methods:From October 2011 to December 2014, a total of 153 patients underwent Stanford A aortic dissection in Cardiovascular surgery, Jilin University second Hospital.The proximal diameter of ascending aorta and aortic regurgitation flow were analyzed by CTA-echocardiography before, before discharge and 6 months after operation.To compare the effect of preoperative aortic valve reflux more than moderate volume only by ascending aortic proximal aortic replacement but not by aortic valve replacement and after aortic valve replacement, the operative time, cardiopulmonary bypass time, aortic clamping time were calculated, and the results of operation, cardiopulmonary bypass (CPB) and aortic occlusion were compared.The duration of circulatory arrest, blood flow, postoperative drainage, postoperative waking time, postoperative ventilator time and ICU stay time, postoperative hospitalization time and postoperative massive bleeding, secondary thoracotomy and hemostasis,The recurrence of proximal dissection and the formation of pseudoaneurysm were summarized and analyzed.Results:Of 153 patients, 9 died in hospital, 144 recovered and discharged. The hospital mortality was about 5.9%.There was no intraoperative death, no aortic wall embedding and right atrial drainage, no intractable proximal anastomotic bleeding, no secondary thoracotomy, no major bleeding, no cardiopulmonary bypass.The aortic occlusion time and circulatory arrest time were not prolonged, the operation time, the blood use decreased, and the drainage flow was less.The aortic CTA and echocardiography were reexamined in 133 patients before discharge, and the aortic CTA and echocardiography were re-examined in 102 patients 6 months after operation. The proximal diameter of ascending aorta and aortic valve reverse flow were all within normal range.There was no recurrence of proximal dissection and pseudoaneurysm.Preoperative aortic valve regurgitation was performed only at the proximal end of ascending aorta without aortic valve replacement. The aortic valve regurgitation was within normal range after operation and mid-term follow-up, and there was no significant difference between patients with aortic valve replacement and patients with aortic valve replacement.All patients were satisfied with the quality of life.Conclusion:The modified proximal ascending aorta forming technique is simple to operate, it can effectively reinforce the broken end of the aorta, reduce the incidence of bleeding from the proximal end of the ascending aorta, reduce the recurrence of proximal dissection and the formation of pseudoaneurysms, etc.It has a good therapeutic effect on aortic valve insufficiency caused by dissection involving the junction of aortic valve. It has a good effect in the surgical treatment of StanfordA aortic dissection and is worth popularizing in clinic.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3

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