中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2011年
8期
456-458,455
,共4页
王韧%孙立忠%朱俊明%张宏家%刘永民%郑斯宏%郑军%刘愚勇%薛金熔%陈雷%王晓龙
王韌%孫立忠%硃俊明%張宏傢%劉永民%鄭斯宏%鄭軍%劉愚勇%薛金鎔%陳雷%王曉龍
왕인%손립충%주준명%장굉가%류영민%정사굉%정군%류우용%설금용%진뢰%왕효룡
主动脉瘤%二尖瓣疾病%心脏外科手术
主動脈瘤%二尖瓣疾病%心髒外科手術
주동맥류%이첨판질병%심장외과수술
Aortic aneurysm%Mitral valve diseases%Cardiac surgical procedures
目的 总结经主动脉切口治疗主动脉根部瘤合并二尖瓣病变的初步经验。方法 2009年3月至2010年12月，经主动脉瓣口行二尖瓣手术16例中男13例，女3例；年龄18～ 75岁，平均(40±10)岁。16例中Bentall+ MVR术12例，Bentall+ MVP术1例，Bentall+全弓置换+支架象鼻+MVP术1例，Bentall+ MVP+ CABG术2例。12例行二尖瓣置换术，其中11例用连续缝合法置换二尖瓣，l例采用间断褥式缝合方法置换二尖瓣。4例行二尖瓣成形术，均为二尖瓣前后交界的Key环缩。术后通过门诊就诊和电话询问进行随访。随访内容包括心功能、瓣膜情况和术后并发症。出院前行经胸心脏超声检查，出院后3、6、12个月各行1次超声检查，以后每年1次。结果 2例再次开胸止血。1例因术后肺部感染给予抗感染治疗后治愈。无围术期及随访期死亡。随方1 ～19个月，平均(7±5)个月。无瓣膜相关并发症。随访期全部患者心功能(NYHA分级)为Ⅰ～Ⅱ级。4例行成形术者中2例二尖瓣房侧微量反流，术后平均随访5个月，随访过程中无进一步发展，患者亦无不适症状。12例二尖瓣置换术者中，1例出院前经胸心脏超声发现二尖瓣短轴9点位收缩期左房侧瓣环外少量反流信号，术后随访过程中无进一步加重。结论 对主动脉根部病变主动脉瓣环扩大合并二尖瓣病变者，经主动脉瓣口行二尖瓣手术，是一种可行的手术路径。
目的 總結經主動脈切口治療主動脈根部瘤閤併二尖瓣病變的初步經驗。方法 2009年3月至2010年12月，經主動脈瓣口行二尖瓣手術16例中男13例，女3例；年齡18～ 75歲，平均(40±10)歲。16例中Bentall+ MVR術12例，Bentall+ MVP術1例，Bentall+全弓置換+支架象鼻+MVP術1例，Bentall+ MVP+ CABG術2例。12例行二尖瓣置換術，其中11例用連續縫閤法置換二尖瓣，l例採用間斷褥式縫閤方法置換二尖瓣。4例行二尖瓣成形術，均為二尖瓣前後交界的Key環縮。術後通過門診就診和電話詢問進行隨訪。隨訪內容包括心功能、瓣膜情況和術後併髮癥。齣院前行經胸心髒超聲檢查，齣院後3、6、12箇月各行1次超聲檢查，以後每年1次。結果 2例再次開胸止血。1例因術後肺部感染給予抗感染治療後治愈。無圍術期及隨訪期死亡。隨方1 ～19箇月，平均(7±5)箇月。無瓣膜相關併髮癥。隨訪期全部患者心功能(NYHA分級)為Ⅰ～Ⅱ級。4例行成形術者中2例二尖瓣房側微量反流，術後平均隨訪5箇月，隨訪過程中無進一步髮展，患者亦無不適癥狀。12例二尖瓣置換術者中，1例齣院前經胸心髒超聲髮現二尖瓣短軸9點位收縮期左房側瓣環外少量反流信號，術後隨訪過程中無進一步加重。結論 對主動脈根部病變主動脈瓣環擴大閤併二尖瓣病變者，經主動脈瓣口行二尖瓣手術，是一種可行的手術路徑。
목적 총결경주동맥절구치료주동맥근부류합병이첨판병변적초보경험。방법 2009년3월지2010년12월，경주동맥판구행이첨판수술16례중남13례，녀3례；년령18～ 75세，평균(40±10)세。16례중Bentall+ MVR술12례，Bentall+ MVP술1례，Bentall+전궁치환+지가상비+MVP술1례，Bentall+ MVP+ CABG술2례。12례행이첨판치환술，기중11례용련속봉합법치환이첨판，l례채용간단욕식봉합방법치환이첨판。4례행이첨판성형술，균위이첨판전후교계적Key배축。술후통과문진취진화전화순문진행수방。수방내용포괄심공능、판막정황화술후병발증。출원전행경흉심장초성검사，출원후3、6、12개월각행1차초성검사，이후매년1차。결과 2례재차개흉지혈。1례인술후폐부감염급여항감염치료후치유。무위술기급수방기사망。수방1 ～19개월，평균(7±5)개월。무판막상관병발증。수방기전부환자심공능(NYHA분급)위Ⅰ～Ⅱ급。4례행성형술자중2례이첨판방측미량반류，술후평균수방5개월，수방과정중무진일보발전，환자역무불괄증상。12례이첨판치환술자중，1례출원전경흉심장초성발현이첨판단축9점위수축기좌방측판배외소량반류신호，술후수방과정중무진일보가중。결론 대주동맥근부병변주동맥판배확대합병이첨판병변자，경주동맥판구행이첨판수술，시일충가행적수술로경。
Objective To explore the experiences of treatment of aortic root aneurysm and mitral valve disease through the incision of aorta.Methods From Mar.2009 to Dec.2010, sixteen patients with aortic root aneurysm and mitral valve disease were operated by transaortic incision.After the leaflets of aortic valve were excised, mitral valve replacement or plasty was performed.There were 13 males and 3 females.The age ranged from 18 to 75 years old with a mean of (40 ± 10) years.The operation procedures included Bentall plus mitral valve replacement in 12 patients, Bentall plus mitral valve plasty in 1,Bentall + total arch replacement + stent elephant trunk + mitral valve plasty in 1, Bentall plus mitral valve plasty and CABG in 1.In 12 patients underwent mitral valve replacement, 11 were using continuous suture and interrupt mattress suture in 1.Four patients underwent mitral valve plasty, the procedure of banding mitral valve leaflets junctions was used.All patients were followed up through telephone and out-patient service.Transthoracic echocardiogram was performed before discharge and 3-, 6-,12-months after operation.Follow-up including cardiac function, valvular and perioperative complications.Results There were 2 re-thoractomy because of bleeding.One patient with pulmonary infection was cured by antibiotics.No death occurred in hospital.Patients were followed-up for 1 to 19 months with a mean of (7 ±5) months.No death occurred during follow-up period.There were no valve-related complications (embolism, bleeding, mitral valve dysfunction).Heart function was improved in all patients and graded as class Ⅰ to Ⅱ (NYHA).Two patients had trace regurgitation after mitral valve plasty when discharged.One patient had mild mitral valve regurgitation was found after mitral valve replacement.There was no further valve exacerbation for above 3 patients during follow-up period.Conclusion Transanrtic mitral valve operation is feasible in patients with aortic root aneurysm and mitral valve disease.
