CAJ | 학술논문

目的评估主动脉根部瘤外科治疗危险因素和疗效.方法 1996年8月至2009年11月,连续92例主动脉根部瘤手术中男56例,女36例;年龄14～77岁,平均(44.8±1.4)岁.合并主动脉夹层动脉瘤45例,中度以上主动脉瓣关闭不全72例,马方综合征47例.行经典Bentall术59例,纽扣法Bentall术13例,主动脉瓣悬吊术14例,用带主动脉窦人工血管作David Ⅰ术6例.结果住院死亡8.7%,并发症率31.7%.随访期死亡18例,远期并发症12例.单变量分析术后并发症危险因素为男性、非马方综合征、同期手术、深低温停循环、主动脉阻断≥120 min和术后第1天输血＞1500 ml;住院死亡危险因素为紧急手术、同期手术、主动脉阻断≥120 min、主动脉夹层和术后第1天输血＞1500 ml.Logistic多因素回归分析认为同期手术和术后第1天输血＞1500 ml是并发症和住院死亡危险因素.所有病人1年、5年和10年生存率分别为(97.1±2.0)%、(88.1±4.7)%和(54.0±9.2)%,平均生存(9.9±0.6)年,95%可信区间8.7～11.0.结论各种主动脉根部瘤手术安全、有效,早、中、长期结果较满意,提倡用纽扣法Bentall术,谨慎选择合适病人作主动脉根部重建术.
목적 평고주동맥근부류외과치료위험인소화료효.방법 1996년8월지2009년11월,련속92례주동맥근부류수술중남56례,녀36례;년령14～77세,평균(44.8±1.4)세.합병주동맥협층동맥류45례,중도이상주동맥판관폐불전72례,마방종합정47례.행경전Bentall술59례,뉴구법Bentall술13례,주동맥판현조술14례,용대주동맥두인공혈관작David Ⅰ술6례.결과 주원사망8.7%,병발증솔31.7%.수방기사망18례,원기병발증12례.단변량분석술후병발증위험인소위남성、비마방종합정、동기수술、심저온정순배、주동맥조단≥120 min화술후제1천수혈＞1500 ml;주원사망위험인소위긴급수술、동기수술、주동맥조단≥120 min、주동맥협층화술후제1천수혈＞1500 ml.Logistic다인소회귀분석인위동기수술화술후제1천수혈＞1500 ml시병발증화주원사망위험인소.소유병인1년、5년화10년생존솔분별위(97.1±2.0)%、(88.1±4.7)%화(54.0±9.2)%,평균생존(9.9±0.6)년,95%가신구간8.7～11.0.결론 각충주동맥근부류수술안전、유효,조、중、장기결과교만의,제창용뉴구법Bentall술,근신선택합괄병인작주동맥근부중건술.
Objective Evaluate the outcome of aortic root reconstruction on the analysis of the risk factors influencing surgical results. Methods Between August 1996 and November 2009, 92 patients(56 men, 36 women) aged from 14 to 77years [mean (44.8 ±1.4) years] with aortic root aneurysm underwent aortic root reconstruction. 72 patients had over moderate aortic valve insufficiency. 47 patients suffered from Marfan syndrome. The aortic pathology was aortic dissection in 45. Bentall technique was used in 59 patients, the button technique in 13, the David I with the Valsalva graft in 6 patients and the aortic valve resuspension in 14 patients. Results The hospital mortality rate was 8.7%. The major complications 31. 7%. 18patients died during the period of follow-up. Late complications among 55 survivors were 12. Univariate predictors of the morbidity were the presence of male, non-Marfan, concomitant procedure, deep hypothermia cardiac arrest, aortic cross clamp time and blood infusion. Risk facts for mortality were emergent or urgent operation, aortic dissection, concomitant procedure, aortic cross clamp time and blood infusion. Multivariate analysis revealed risk factors of concomitant procedure and blood infusion were responsible for both morbidity and mortality. The overall long-term survival rate is (97.1 ±2.0)% at 1-year, (88.1 ±4.7)% at 5-year, (54.0 ±9.2)% at 10-year. The mean for survival time is (9.9 ±0.59) years, 95% confidence interval 8.70 -11.01. Conclusion The aortic root restitution procedures are safe and effective in general. The short and long-term outcome is satisfactory. The button technique is the first choice for reimplantation coronary patch. Valve-sparring aortic root reconstructions show promise in safety and applicability.