一种简单易复制的A型主动脉夹层根部处理方式

目的 使用主动脉根部全间断褥式缝合、联合内引流技术治疗A型主动脉夹层，总结早中期结果。方法 回顾2018年6月至2020年12月我科行A型主动脉夹层手术患者46例。根据主动脉根部处理方式分为三组：根部间断缝合组18例，根部置换组（Bentall和Cabrol术组）17例，根部连续缝合组11例。对比三组间术前资料、围术期及随访结果。结果 全组男性32例（69.6%），年龄（57.2±11.9）岁，发病24h内急诊手术29例（63%）。三组之间性别、年龄无明显差异，手术时机、术前心功能无差异，主动脉根部替换组术前窦部直径显著高于其他两组置换组（44.2±8.3） mm , 间断组(35.9±3.2)mm ,连续组(35.9±4.0)mm， P<0.01），主动脉瓣反流程度也更严重。35例患者全弓置换，8例行半弓置换，3例未行弓部手术。主动脉阻断时间（121.5±23.7）min，体外循环时间（262.2±78.8）min，根部置换组时间较长。存活39例（84.8%），三组之间死亡率、术后ICU停留天数、输血量、术后住院时间无显著差异。随访3月~3年，无轻度以上主动脉瓣反流，心功能良好；随访CTA结果良好。结论 主动脉根部间断缝合联合内引流的方法操作简单、可复制性强，近期手术效果与其他方法相当，可作为现有手术方法的一种补充。

A Simple and Reproducible Surgical Management of Aortic Root in Type A Aortic Dissection

Objective Interrupted pledget sutures combined with self-drainage technique were applied to reconstruct aortic root when repairing type A aortic dissection, and the outcomes were summarized. Methods Forty-six patients with type A aortic dissection who underwent operation from June 2018 to December 2020 were retrospectively reviewed. They were divided into three groups according to the management of the aortic root: Interrupted repair group (N=18), root replacement group (N=17), running repair group (N=11). The perioperative data and outcomes were compared among the groups. Results There were 32 males (69.6%), and the mean age was 57.2±11.9 years. Twenty-nine patients (63%) had emergent operation within the first 24 hours from onset of dissection. There were no differences of gender, age, time of operation and preoperative heart function within the groups. The mean diameter of sinus-tube junction in the root replacement group was significantly higher than the other two groups (root replacement group 44.2±8.3 mm vs interrupted repair group 35.9±3.2mm vs running repair group 35.9±4mm, P<0.01), and aortic insufficiency was worse in the root replacement group. The aortic clamped time was 121.5±23.7min, and cardiopulmonary bypass time was 262.2±78.8min. The root replacement group cost longer time. There were 39 survivors (84.8%), and no difference of mortality, days of ICU stay, transfusion volumes, days of postoperative hospitalization was found among the groups. During the follow-up of 3 months to 3 years, echocardiography demonstrated no more than mild aortic insufficiency, and the heart function was normal. The postoperative CT angiography showed good results.Conclusions This Interrupted pledget sutures combined with self-drainage technique was simple and reproducible. The short-term outcomes were comparable to other techniques. It provides an alternative to the current surgeries.