主动脉瓣病变合并升主动脉扩张的外科治疗效果

目的探讨主动脉瓣病变合并升主动脉扩张的外科治疗临床效果。方法选择本科室2013年1月至2016年7月收治的80例主动脉瓣病变合并升主动脉扩张患者为研究对象,根据手术类型将其分为单纯组(40例,单纯主动脉瓣置换术)、同期升主动脉成形组(17例,主动脉瓣置换术同期升主动脉成形术)及同期升主动脉置换组(23例,主动脉瓣置换术同期升主动脉置换术)。比较三组患者的主动脉阻断时间、体外循环时间、术后早期并发症及主动脉不良事件发生情况,比较不同病变类型患者术前及术后升主动脉直径及扩张速率。结果单纯组患者的主动脉阻断时间、体外循环时间明显短于同期升主动脉成形组、同期升主动脉置换组(P<0.05)。三组患者的术后早期急性肾衰竭、术后出血、术后心房颤动、完全右束支传导阻滞发生率比较,差异无统计学意义(P>0.05)。术后,主动脉瓣狭窄、主动脉瓣关闭不全、混合病变患者的升主动脉直径、升主动脉扩张速率均降低,差异显著(P<0.05);但组间比较,差异无统计学意义(P>0.05)。术后随访2年,三组患者均无严重主动脉不良事件发生。结论主动脉瓣病变合并升主动脉扩张实施单纯主动脉瓣置换术及同期升主动脉成形、升主动脉置换术治疗均可达到良好的治疗效果,但实施单纯主动脉瓣置换术的主动脉阻断时间、体外循环时间更短,临床可根据患者实际需求选择术式。

Clinical efficiency of surgical treatment in aortic valve disease combined with ascending aortic dilation

Objective To explore the clinical efficiency of surgical treatment in aortic valve disease with ascending aortic dilation. Methods Eighty patients with aortic valve disease with ascending aortic dilatation from January 2013 to July 2016 in our department were selected as study objects. The patients were divided into simple group (n=40, simple aortic valve replacement), ascending aorta formation group (n=17, aortic valve replacement combined with ascending aorta formation surgery) and ascending aorta replacement group (n=23, aortic valve replacement combined with ascending aorta replacement surgery) according to surgery types. The aortic occlusion time, extracorporeal circulation time, early postoperative complications and adverse events of aorta among the three groups were compared, and the ascending aorta diameter, ascending aorta expansion rates before and after operation in patients with different lesion types were compared. Results The aortic block time and extracorporeal circulation time in the simple group were shorter than those in the ascending aorta formation group and ascending aorta replacement group (P<0.05). There were no significant differences in the incidences of early acute renal failure, postoperative hemorrhage, postoperative atrial fibrillation and complete right bundle branch block among the three groups (P>0.05). After operation, the ascending aorta diameter and ascending aorta expansion rates in patients with aortic stenosis, aortic regurgitation, mixed lesions decreased, the differences were statistically significant (P<0.05), but there were no significant differences among the three groups (P>0.05). After 2 years of follow-up, there was no serious aortic complications occurred in the three groups. Conclusion Simple aortic valve replacement, simultaneous ascending aorta formation and ascending aortic replacement in the treatment of aortic valve disease combined with ascending aortic dilatation can achieve good therapeutic effect, but simple aortic valve replacement has shorter aortic block time and extracorporeal circulation time, the surgical procedure can be selected according to the actual needs of patients.