【作者】 王鑫鑫；

【导师】 马量；

【作者基本信息】 浙江大学 ， 临床医学八年制（专业学位）， 2016， 博士

【摘要】 目的：本研究通过对比单纯行主动脉瓣置换术和主动脉瓣置换术同时行升主动脉包裹术在治疗升主动脉扩张的近中期疗效,探讨升主动脉包裹术的临床应用价值。方法：回顾性分析2010年1月1日-2015年12月31日在浙大一院因主动脉瓣病变同时伴有升主动脉扩张而行主动脉瓣置换术或者同时行升主动脉包裹术的患者,其中单纯行主动脉瓣置换术组72例,主动脉瓣置换术同时行升主动脉包裹术组77例,收集并比较两组体外循环时间、主动脉阻断时间、手术持续时间、术中出血量、ICU住院时间、术后住院时间、引流量、术后血制品使用量、气管插管时间、术后近中期并发症、随访心超记录的升主动脉最大直径、左室射血分数、左室大小等指标,评价升主动脉包裹术的近中期疗效。结果：单纯行主动脉瓣置换术组与主动脉瓣置换术同时行升主动脉包裹术组的患者术前一般情况相比,后者在升主动脉最大直径上较前者明显更宽(P<0.001),其他如年龄、性别、合并症、心功能、主动脉瓣病变类型及程度、左室收缩功能、大小等方面均没有明显差异。两组在体外循环时间、主动脉阻断时间、手术时间、术中出血量、引流管留置时间、气管插管时间、术后血制品使用量、术后住院时间上均没有显著性差异。单纯主动脉瓣置换组有1例术后出现胸骨感染,有1例出现脑血管意外,升主动脉包裹术组术后有1例因多脏器功能衰竭死亡,2例因术后引流量过多行开胸探查止血,其他如恶性心律失常、心包填塞、急性心肌梗死等并发症,两组均没有发生。主动脉瓣置换术组在随访期间,有1例患者出现瓣周漏,2例患者死亡,升主动脉包裹术组没有死亡或并发症发生。主动脉瓣置换术组术前升主动脉最大直径平均为44.7±4.5mm,术后直径平均为43.2±k4.8mm,较术前直径没有明显差异,末次随访直径平均为44.3±5.5mm,较术后直径没有显著性差异。升主动脉包裹术组术前升主动脉最大直径平均48.3+5.6mm,术后直径为38.5±5.1mm,末次随访直径平均为39.0±5.1mm,术后直径较术前明显缩小(P<0.001),末次随访直径较术后直径没有显著性差异。结论：升主动脉包裹术是一种治疗升主动脉扩张安全可靠的手术方式,近中期疗效确切,其远期效果还需进一步研究。更多还原

【Abstract】 Objectives:The study compares the late to mid-term results of aortic valve replacement and aortic valve replacement combined with aorta wrapping for aortic valve disease with a dilated ascending aorta to discuss the clinical value of aorta wrapping.Methods:The study enrolled 149 consecutive patients in the presence of aortic valve disease with dilated ascending aorta undergoing aortic valve replacement or aorta wrapping in our hospital from January 1st,2010 to December 31,2015. We collected and compared the cardiopulmonary bypass time, aortic blocking time, surgery time, bleeding volume during surgery, ICU days, in-hospital days after surgery, drainage volume, drain time, blood transfusion volume, mechanical respiration time, late complications, follow-up echocardiography between aortic valve replacement group and aortic valve replacement combined with aorta wrapping group to evaluate the late to mid-term results of aorta wrapping.Results:Baseline characteristics such as age, gender, comorbidities, heart function, aortic valve diseases, left ventricle systolic function and size of aortic valve replacement group and aortic valve replacement combined with aorta wrapping group are similar except the ascending aorta diameter which is larger in the latter group (p<0.001). Cardiopulmonary bypass time, aortic blocking time, surgery time, bleeding volume during surgery, pathology of aortic valve, ICU days, in-hospital days after surgery, drainage volume, drain time, blood transfusion volume, mechanical respiration time are of no significant difference between both group. One sternum infection, one cerebrovascular accident occurred in aortic valve replacement group. One death of multi-organ failure, two re-explorations occurred in aorta wrapping group. No other complications such as malignant arrhythmia, cardiac tamponade, acute myocardial infarction occurred in both group. During follow up, one paravalvular leakage and two death occurred in aortic valve replacement group. No death or complications occurred in aorta wrapping group. The average ascending aorta diameter was 44.7±4.5 mm before surgery,43.2±4.8 mm after surgery and 44.3±5.5 mm at last follow up in aortic valve replacement group (P>0.05). The average ascending aorta diameter was 48.3±5.6 mm before surgery,38.5±5.1 mm after surgery and 39.0±5.1 mm at last follow up in aortic valve replacement group. there is significant difference between the average ascending aorta diameter before sugery and after surgery (P<0.001), and no significant difference after surgery and at last follow up (P>0.05).Conclusions:Aorta wrapping technique is a safe and reliable surgery for dilated ascending aorta. The late to mid-term results of it is promising. The long-term results need to be studied.更多还原