非特异性主动脉炎合并主动脉瓣病变的外科治疗

Surgical treatment on aortic valve disease combined with non-specific aortitis

目的总结非特异性主动脉炎合并主动脉瓣病变初次和再次手术的方法和疗效。方法2000年1月至2011年6月手术治疗34例非特异性主动脉炎合并主动脉瓣病变患者，其中23例主动脉炎，11例白塞病。初次手术行Bentall术18例，主动脉瓣置换术（AVR）16例。16例AVR者14例术后并发严重瓣周漏再次手术，其中根部置换术10例，人工带瓣管道8例，同种带瓣管道2例；非原位AVR术后4例。结果初次手术行Bentall术者18例，随访4个月-11年，均长期生存，无根部假性瘤。再次手术14例均生存，出院。l例行同种带瓣管道置换术患者术后14个月因根部假性瘤破裂死亡。结论非特异性主动脉炎合并主动脉瓣病变患者术前明确诊断困难，漏诊率极高。初次手术应采用根部置换术，再次手术十分困难，根部置换术可取得比较好的疗效，非原位AVR术操作简单、术中止血容易，术后疗效可靠，是一种可供选择的有效方法。’

Objective To summary the methods and results of first and second operations on patients with aortic valve disease and non-specific aortitis. Methods The total 34 patients including 23 cases with aortitis and 11 cases with Beheet disease were studied from Jan 2000 to Dec 2010. The first operation was Bentall procedure in 18 cases and AVR in 16 cases. Fourteen of 16 eases who had AVR developed severe paravalvular leakage, and undewent the second operation including 10 aortic root replacement （8 valve-conduit and 2 homograft） and 4 non-anatomic AVR. Results Eighteen patients who had first operation of Bentall procedure all survive without aortic pseudoaneurysm after the follow-up of 6 months to 11 years. Fourteen redo cases all survive except for one case died of repture of aortic pseudoaneurysm 1.2 years postoperatively. Conclusion Preoperative diagnosis in these patients is very difficulty. The first operation of root replacement is of choice. The second operation is very difficulty to handle, root replacement can achieve satisfactory results. Non-anatomic AVR is easy to perform, and good hemo stasis intraoperatively, and is a satisfied alternative method with good results.