【摘要】：目的對(duì)主動(dòng)脈竇瘤破裂(ruptured sinus of Valsalva aneurysm,RSVA)的Sakakibara分型進(jìn)行改良,探討其改良分型法對(duì)手術(shù)修補(bǔ)的指導(dǎo)意義。方法回顧性分析2006年2月至2012年1月期間159例在阜外心血管病醫(yī)院接受RSVA修補(bǔ)術(shù)患者的臨床資料,男105例,女54例;年齡2～71(33.4±10.7)歲。所有患者按改良Sakakibara分型歸入5類(lèi),Ⅰ型:竇瘤破入肺動(dòng)脈瓣下(n=66),其中84.8%合并室間隔缺損(VSD),53.8%合并主動(dòng)脈瓣關(guān)閉不全(AI);Ⅱ型:竇瘤破入右心室室上嵴或嵴下(n=17),88.2%合并VSD,23.5%合并AI;Ⅲ型:竇瘤在靠近三尖瓣環(huán)處破入右心室(Ⅲv型,n=6)或右心房(Ⅲa型,n=21),18.5%合并VSD,25.9%合并AI;Ⅳ型:竇瘤破入右心房(n=46),23.9%合并AI,無(wú)VSD;Ⅴ型:其他罕見(jiàn)情況,如竇瘤破入左心房、左心室、肺動(dòng)脈或其他部位(n=3),全部合并AI,33.3%合并VSD。大部分竇瘤起自主動(dòng)脈右冠竇(n=122),另有35例起自無(wú)冠竇,僅2例起自左冠竇。結(jié)果 100%的Ⅴ型和50%的Ⅲv型RSVA患者單純經(jīng)主動(dòng)脈切口入路進(jìn)行修補(bǔ)。大多數(shù)Ⅰ型、Ⅱ型和Ⅳ型患者單純從竇瘤破入的心腔側(cè)進(jìn)行修補(bǔ)(所占比率分別為71.2%、64.7%和69.6%),76.2%的Ⅲa型患者同時(shí)使用上述2個(gè)徑路完成修補(bǔ)。其中Ⅳ型患者體外循環(huán)時(shí)間[(92.4±37.8)min]和主動(dòng)脈阻斷時(shí)間[(61.2±30.7)min]最短。全組無(wú)手術(shù)死亡,2例(Ⅰ型、Ⅱ型各1例)在術(shù)后早期因右心室流出道再狹窄而二次手術(shù)矯治。對(duì)絕大多數(shù)患者采用補(bǔ)片材料加固竇瘤的修復(fù)方法(n=149),僅10例患者(其中Ⅳ型5例、Ⅲa型4例、Ⅱ型1例)采用單純線性縫合竇瘤的方法。33例患者同期接受主動(dòng)脈瓣置換術(shù)(66.7%為Ⅰ型)。隨訪147例(92.5%),2例(Ⅰ型、Ⅲa型)術(shù)后因心房顫動(dòng)而接受射頻消融治療,1例(Ⅳ型)因殘余分流再次手術(shù),隨訪期間無(wú)遠(yuǎn)期死亡。結(jié)論 RSVA的改良Sakakibara分型法對(duì)選擇手術(shù)修補(bǔ)入路具有臨床指導(dǎo)意義,各種類(lèi)型的RSVA均可以取得良好的手術(shù)治療效果。
[Abstract]:Objective to improve the Sakakibara classification of ruptured aortic sinus aneurysm (ruptured sinus of Valsalva aneurysm,RSVA) and to explore the significance of the modified classification in surgical repair. Methods the clinical data of 159 patients undergoing RSVA repair in Fuwei Cardiovascular Disease Hospital from February 2006 to January 2012 were retrospectively analyzed. 105 males and 54 females, aged 23.4 鹵10.7 years, were enrolled in this study. All patients were classified into 5 groups according to modified Sakakibara classification. Type I: sinus aneurysm ruptured into subpulmonary valve (nnm66), of which 84.8% were associated with ventricular septal defect (VSD),) and 53.8% with aortic valve insufficiency (AI);). Type 鈪，

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