改良Bentall术对马凡综合征主动脉根部瘤的治疗效果

Modified Bentall procedures for aortic root aneurysm related to Marfan's syndrome

目的评价改良Bentall手术对马凡综合征主动脉根部瘤的临床治疗效果。方法 1999年7月至2009年8月共收治36例马凡综合征主动脉根部瘤患者,其中16例采用常规Bentall术(CG组),20例采用改良Bentall术(MG组),比较两组临床效果。结果 CG组住院死亡1例(6.3%),MG组无死亡病例。MG组术中失血量少于CG组[(428.0±66.8)mlvs.(839.5±95.4)ml)],差异有统计学意义(P<0.05)。MG组患者主动脉阻断时间、转机时间、手术操作时间均较CG组短,但差异无统计学意义(P>0.05)。MG组患者术后12h引流较CG组少[(420.6±236.4)mlvs.(615.3±259.6)ml],差异有统计学意义(P<0.05)。MG组患者围术期输注悬浮红细胞量为(2.0±0.8)U,较CG组少[(4.8±2.1)U,P<0.05]。随访2～98个月,两组均无死亡病例,每组各有1例患者接受二次手术。结论改良Bentall手术可以减少患者手术失血量,缩短手术时间,中期随访临床效果良好,可安全用于马凡综合征主动脉根部瘤的外科治疗。

Objective To evaluate the effectiveness of modified Bentall procedure for aortic root aneurysm related to Marian＇s syndrome. Methods Between July 1999 and August 2009, 36 consecutive Marian＇s syndrome patients with aortic root aneurysm underwent aortic root replacement. Patients were divided into two groups according to the surgery pro- cedures. Modified Bentall procedures was performed in 20 patients （group M）, and conventional Bentall operation were performed in 16 patients （group C）. The clinical outcomes were observed. Results The in-hospital mortality was 6.3%, including one patient died of multi-organ failure 4 day after operation in group M. The volume of blood loss in Group C[（839.5±95.4）ml] was significantly more than that in Group M [（428.0±66.8）ml）]. One patient in group C required reexplo- ration of the chest for bleeding complications. Patients had longer intra-operative aortic cross-clamp times[（103.7±29.3）min vs. （90.6 ±24.5）min], cardiopulmonary bypass times [（166.2±32.5）min vs. （145.4±28.0）mini, and operative times [（237.4±79.3）rain vs. （210.2±64.7）rain] in group C than group M, but the differences were not statistically significant （P 〉 0.05）. Postoperative drainage volume and the volume of blood transfusion required were less in group M than group C [（420.6±236.4）ml vs. （615.3±259.6）ml, （2.0±0.8）U vs. （4.8±2.1）U, P 〈 0.05）. The time of follow-up was 2-98 moths and the survival rate was 100%. Two patients required reoperation for distal descending aorta replacement because of descending aortic extension. Conclusions The modified Bentall procedures is an excellent method for aortic root aneurysm related to Marfan＇s syndrome, and it can improve hemostasis and shorten operation time. The technique can be considered as a useful and alternative operation approach.