【摘要】：目的分析升主動(dòng)脈成形術(shù)治療主動(dòng)脈瓣病變合并升主動(dòng)脈擴(kuò)張的中期臨床療效。方法回顧性地分析2010年1月至2013年12月因主動(dòng)脈瓣病變合并升主動(dòng)脈擴(kuò)張于我院行主動(dòng)脈瓣置換術(shù)合并升主動(dòng)脈成形術(shù)的患者。入組患者102例,所有患者均接受主動(dòng)脈瓣置換術(shù)合并升主動(dòng)脈成形術(shù),按照術(shù)前診斷及術(shù)后病理結(jié)果將主動(dòng)脈瓣二瓣化患者(57例)和主動(dòng)脈瓣非二瓣化患者(45例)分組進(jìn)行分析。患者平均年齡為52.7±12.9歲,男性患者占71.6%,42.2%術(shù)前心功能分級(jí)大于2級(jí),術(shù)前左心室舒張末徑為56.9±9.1mm,射血分?jǐn)?shù)為61.3%±8.9%,術(shù)前主動(dòng)脈竇部?jī)?nèi)徑為35.9±5.3mm,術(shù)前升主動(dòng)脈內(nèi)徑為45.6±4.9mm。結(jié)局事件為術(shù)后死亡、再次手術(shù)、腦卒中、主動(dòng)脈不良事件(夾層、破裂)。結(jié)果對(duì)所有入組患者術(shù)后隨訪資料進(jìn)行分析,平均隨訪時(shí)間為38.8±13.0月。兩組患者在年齡上存在統(tǒng)計(jì)學(xué)差異(二瓣化組49.5±13.5歲vs.非二瓣化組56.8±10.9歲,P=0.004),非二瓣化組較二瓣化組有更多患者合并二尖瓣病變(p0.01)及合并三尖瓣關(guān)閉不全(p0.01),術(shù)前左心房?jī)?nèi)徑二瓣化組明顯小于非二瓣化組(p=0.004),二瓣化組較非二瓣化組有更多患者術(shù)前升主動(dòng)脈內(nèi)徑大于45mm(p=0.004),其余基線資料均具有可比性。術(shù)后死亡2例,腦卒中1例,無再次手術(shù)及發(fā)生主動(dòng)脈不良事件患者。所有患者術(shù)后左心房?jī)?nèi)徑、左室舒張末期內(nèi)徑、主動(dòng)脈竇部?jī)?nèi)徑、升主動(dòng)脈內(nèi)徑均較術(shù)前明顯減小(p0.001)。所有隨訪升主動(dòng)脈內(nèi)徑較術(shù)后擴(kuò)張的患者平均主動(dòng)脈擴(kuò)張程度為0.39±0.26cm,平均主動(dòng)脈內(nèi)徑擴(kuò)張速率為1.3±0.8mm/y.所有患者隨訪升主動(dòng)脈內(nèi)徑較術(shù)后存在擴(kuò)張(36.6±4.8mm vs. 35.5±4.6mm,p=0.014),其中二瓣化組(37.0±5.0mm vs.35.5±4.6mm,p=0.009),非二瓣化組(36.1±4.7m vs.35.5±4.6mm=,p=0.188).結(jié)論對(duì)于主動(dòng)脈瓣病變合并升主動(dòng)脈擴(kuò)張的患者,主動(dòng)脈瓣置換同期行升主動(dòng)脈成形術(shù)中期療效安全可靠,二瓣化患者術(shù)后升主動(dòng)脈較非二瓣化患者更易擴(kuò)張,遠(yuǎn)期療效仍需進(jìn)行隨訪觀察。
[Abstract]:Objective to analyze the mid-term clinical effect of ascending aortic angioplasty in the treatment of aortic valve disease with ascending aortic dilatation. Methods from January 2010 to December 2013, patients undergoing aortic valve replacement combined with ascending aortic angioplasty in our hospital due to aortic valve disease combined with ascending aortic dilatation were retrospectively analyzed. 102 patients were treated with aortic valve replacement combined with ascending aortic angioplasty. According to preoperative diagnosis and postoperative pathological results, 57 patients with aortic valve bivalvalization and 45 patients with non-bivalve aortic valve were divided into two groups. The mean age of the patients was 52.7 鹵12.9 years. The mean age of the patients was 52.7 鹵12.9 years old. The mean preoperative cardiac function grade was 71.6% and 42.2%. The left ventricular end-diastolic diameter was 56.9 鹵9.1 mm, the ejection fraction was 61.3% 鹵8.9 mm, the preoperative aortic sinus diameter was 35.9 鹵5.3 mm, and the preoperative ascending aortic diameter was 45.6 鹵4.9 mm. The outcome events were postoperative death, reoperation, stroke, aortic adverse events (dissection, rupture). Results the mean follow-up time was 38.8 鹵13.0 months. There was a significant difference in age between the two groups (49.5 鹵13.5 years old vs. in the two-valvular group). There were more patients with mitral valve disease (p0.01) and tricuspid insufficiency (p0.01) in the non-bivalvalization group than in the two-valvuloplasty group (p0.01). The preoperative left atrial diameter in the double-valvular group was significantly lower than that in the non-bicuspid valve group (p0.004), and that in the bicuspid group was significantly lower than that in the non-bicuspid valve group (p0.01). In the valvular group, the diameter of ascending aorta was larger than that of 45mm (p0. 004), and the other baseline data were comparable. There were 2 cases of postoperative death, 1 case of stroke, no reoperation and adverse events of aorta. The left atrial diameter, left ventricular end-diastolic diameter, aortic sinus diameter and ascending aortic diameter were significantly decreased in all patients (p0.001). The mean degree of aortic dilatation was 0.39 鹵0.26 cm and the average aortic diameter dilation rate was 1.3 鹵0.8 mm / y in all patients who were followed up with ascending aortic diameter compared with postoperative dilatation. All patients were followed up with dilatation of the ascending aorta (36.6 鹵4.8mm vs. 35.5 鹵4.6 mm, p0.014), including the double-valved group (37.0 鹵5.0mm vs.35.5 鹵4.6 mm, p0.009) and the non-double-valved group (36.1 鹵4.7 m vs.35.5 鹵4.6 mm vs.35.5, 0.188). Conclusion for patients with aortic valve disease combined with ascending aortic dilatation, aortic valve replacement combined with ascending aortic angioplasty is safe and reliable in the middle stage, and the ascending aorta is more easily dilated in patients with double valve replacement than in patients with non-bivalvolution. The long-term effect still needs to be followed up.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

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