摘要
目的:回顾性分析25例患者主动脉瓣术后再发主动脉夹层的外科治疗,提高对主动脉瓣术后主动脉夹层病变的防治认识。方法:收集2003-06至2012-06我院主动脉瓣术后再发主动脉夹层患者25例,其中男20例,女5例,再次手术间隔时间(4.79±2.73)年。行主动脉根部替换4例,升主动脉替换6例,升主动脉+全弓替换+象鼻支架植入13例,全胸腹主动脉替换2例。对所有出院患者均进行了门诊复查和电话随访。结果:在本组中,25例患者均为A型夹层,急性主动脉夹层10例(40%),慢性主动脉夹层15例(60%);原发破口位置:窦管交界处8例,升主动脉前壁7例,后壁6例,弓部小弯侧4例。体外循环时间平均(181±61)min;住院时间(22±10)天。术中死亡1例;术后肾功能不全5例,经血滤治疗后好转;神经功能障碍7例,包括一过性神经功能障碍4例,局灶性脑梗塞3例,无轻瘫、截瘫等脊髓功能不全发生。马凡综合征患者升主动脉直径年增长值(4.3±3.3)mm(P<0.05)。术后随访100%,平均随访时间(52.32±26.23)个月,3年生存率85%。结论:主动脉瓣置换术后夹层再手术风险是可以接受的,再手术死亡率较初次手术没有明显增加。
Objective： To analyze the surgical treatment for recurrence of aortic dissection in patients after aortic valve replacement （AVR） in order to improve the clinical practice for treating such patients. Methods： We retrospectively studied 25 patients who received reoperation for aortic dissection after AVR in our hospital from 2003-06 to 2012-06. The interval time between 2 operations was （4.79±2.73） years. There were 4 patients received Bentall＇s procedure, 6 received ascending aortic replacement, 13 received ascending aortic arch ＋ total aortic arch replacement ＋ elephant trunk procedure and 2 received total thoracic and abdominal aorta replacement. All patients were recorded by office visit and telephone interview. Results： All 25 patients suffered from type A dissection including 10 （40%） acute and 15 （60%） chronic aortic dissection. There were 8 patients with the original rupture at the border of sinus and tubing, 7 at the front wall of ascending aorta, 6 at the back wall of ascending aorta and 4 at aortic arch. The average extracorporeal circulation time was （181±61） min and the in-hospital time was （22±10） days. There were 1 patient died during the operation, 5 with post operative renal insufficiency and they were improved by hemofiltration, 7 with neurological complication including 4 transient brain dysfunction and 3 local brain infarction. No post operative spinal cord deficits occurred. The patients with Marfan syndrome had the ascending aorta growth at （4.3±3.3） mm per year, P〈0.05. All patients were followed-up for （52.32±26.23） months and the 3-year survival rate was at 85%. Conclusion： The re-operative risk was acceptable in patients with aortic dissection after AVR, the mortality for re- operation was not obviously higher than the first operation.
出处
《中国循环杂志》
CSCD
北大核心
2014年第3期224-227,共4页
Chinese Circulation Journal
