白塞氏病致主动脉瓣关闭不全的外科治疗

Surgical Treatment of Aortic Regurgitation Caused by Behcet's Disease

目的总结白塞氏病所致主动脉瓣关闭不全的外科疗效,探讨相关手术方式。方法回顾性分析1997年4月～2004年5月在我院收治的白塞氏病所致主动脉瓣关闭不全的病例8例,其中外院术后再次入院2例,我院首次收治6例。外院2例首次均在外院行主动脉瓣替换术(AVR),转入我院后1例行AVR,1例行同种主动脉Bentall手术。我院首次收治6例中,3例行AVR熏3例行主动脉根部替换术(ARR),ARR中Bentall手术2例,Cabrol手术1例。结果住院期间1例患者因左心衰竭死亡。随访3～36个月(平均26个月间),无1例患者死亡。首次AVR术后5例,因机械瓣松动二次手术2例;三次手术2例,包括1例二次行同种主动脉Bentall手术后再次行AVR;余1例瓣膜松动尚未手术。首次即行根部替换术的3例,术后无瓣膜松动和瓣周漏发生。结论白塞氏病所致主动脉瓣关闭不全应首选主动脉根部替换术。

Objective To summarize operational effect with surgical treatment of aortic regurgitation caused by Behcet's disease and discuss relevant surgical techniques for treatment of these conditions. Methods Eight patients with aortic regurgitation secondary to Behcet's disease and received surgery between April 1997 and August 2003 were retrospetively analyzed. Among them, two patients had their aortic valves replaced in other hospital before admitted to our hospital where one undertook aortic valve replacement(AVR), and the other undertook aortic root replacement(ARR). In six patients who were initially treated in our hospital, the surgical procedures for aortic regurgitation included AVR in three patients and ARR operation in other three patients in whom Bentall-type operation was conducted in two patients and Cabrol-type operation in one. Results One patient died during hospital stay. The follow-up periods ranged from 3 months to 36 months. In five patients with prosthetic valve detachment or suture detachment, redo homograft replacement was required in one patient and redo AVR in 3, one patient had redo AVR twice, and the remaining one patient had no surgery at present. Three patients primarily operated by ARR operation have no complications. Conclusions The rate of prosthetic valve detachment is high in patients with Behcet's disease. ARR should be a first-line therapy for operation promised these patients.