本文選題：主動(dòng)脈夾層 + 吻合口出血�。� 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的： 描述改良升主動(dòng)脈近端成形的手術(shù)方法和技術(shù)要點(diǎn)，探討此方法在StanfordA型主動(dòng)脈夾層手術(shù)中應(yīng)用的臨床療效。 材料和方法： 收集自2011年10月至2014年12月，于吉林大學(xué)第二醫(yī)院心血管外科行Stanford A型主動(dòng)脈夾層手術(shù)并于術(shù)中應(yīng)用改良升主動(dòng)脈近端成形方法的病例共153例。通過(guò)主動(dòng)脈CTA、心臟彩超的檢查結(jié)果，對(duì)患者術(shù)前、出院前、術(shù)后6個(gè)月隨訪的升主動(dòng)脈近端直徑、主動(dòng)脈瓣反流量進(jìn)行統(tǒng)計(jì)和對(duì)比分析；對(duì)比術(shù)前主動(dòng)脈瓣中等量以上反流僅行升主動(dòng)脈近端成形而未行主動(dòng)脈瓣置換病例和行主動(dòng)脈瓣置換病的術(shù)后效果；并統(tǒng)計(jì)患者的手術(shù)時(shí)間、體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間、停循環(huán)時(shí)間、術(shù)中用血量、術(shù)后引流量、術(shù)后清醒時(shí)間、術(shù)后應(yīng)用呼吸機(jī)時(shí)間、ICU停留時(shí)間、術(shù)后住院時(shí)間及有無(wú)術(shù)后大出血、二次開胸止血、近端夾層復(fù)發(fā)和假性動(dòng)脈瘤形成等嚴(yán)重并發(fā)癥，進(jìn)行總結(jié)分析。 結(jié)果： 全組153例患者住院死亡9例，，痊愈出院144例，住院死亡率約為5.9%。全組無(wú)術(shù)中死亡，無(wú)術(shù)中行主動(dòng)脈壁包埋及右心房引流處置，無(wú)難以控制的近端吻合口出血而二次轉(zhuǎn)機(jī)止血，無(wú)術(shù)后二次開胸止血，術(shù)后無(wú)因大出血死亡，體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間、停循環(huán)時(shí)間無(wú)明顯延長(zhǎng)，手術(shù)時(shí)間、術(shù)中用血減少，術(shù)后引流量較少。出院前133人復(fù)查主動(dòng)脈CTA及心臟彩超，術(shù)后6個(gè)月102人復(fù)查主動(dòng)脈CTA及心臟彩超，所有復(fù)查患者升主動(dòng)脈近端直徑及主動(dòng)脈瓣反流量均為正常范圍內(nèi)，無(wú)近端夾層復(fù)發(fā)及假性動(dòng)脈瘤形成。術(shù)前主動(dòng)脈瓣反流僅行升主動(dòng)脈近端成形而未行主動(dòng)脈瓣置換病例術(shù)后及中期隨訪主動(dòng)脈瓣反流量均在正常范圍內(nèi)，與主動(dòng)脈瓣置換病例無(wú)明顯差異。中期隨訪無(wú)出院后死亡，所有患者對(duì)生活質(zhì)量滿意。 結(jié)論： 改良升主動(dòng)脈近端成形技術(shù)操作簡(jiǎn)單，可有效地加固主動(dòng)脈斷端，減少升主動(dòng)脈近端吻合口出血的發(fā)生率，有效的減少近端夾層復(fù)發(fā)及假性動(dòng)脈瘤形成等并發(fā)癥的發(fā)生，對(duì)因夾層累及主動(dòng)脈瓣交界而引起的主動(dòng)脈瓣關(guān)閉不全有良好的治療效果，在StanfordA型主動(dòng)脈夾層的手術(shù)治療中有較好的療效，值得臨床推廣。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.3

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