主动脉瓣瓣周脓肿的外科治疗

Surgical treatment for aortic periannular abscess

目的总结外科手术治疗主动脉瓣瓣周脓肿的疗效。方法回顾性分析2009年1月—2019年6月我院收治的35例主动脉瓣瓣周脓肿患者的临床资料,男21例、女14例,年龄36~67(53.0±12.3)岁。自体主动脉瓣心内膜炎14例,人造心脏瓣膜心内膜炎21例(机械瓣16例,生物瓣5例)。术前血培养阳性15例,其中金黄色葡萄球菌8例,表皮葡萄球菌2例、草绿色链球菌3例,铜绿假单胞菌1例,肠球菌1例。结果 11例患者行急诊或紧急的手术治疗。30例患者行主动脉瓣置换术,5例行改良Cabrol手术直接替换主动脉根部。术后早期主要并发症包括二次开胸止血1例,低心排血量综合征8例,肾功能不全5例,呼吸功能不全10例,气管切开3例,肺部感染8例和脑血管意外1例。术后随访6~120(53.6±20.8)个月,随访期间4例死亡,4例失访。随访中无感染复发。有3例患者术后出现瓣周漏,1例于术后12个月行封堵术。生存曲线提示术后1年生存率85.5%,术后5年生存率67.3%。结论主动脉瓣周脓肿的病变虽然复杂危重,但通过围术期有效的抗生素治疗,个体化选择手术时机,合适的手术策略,可以明显降低死亡率并取得较好的疗效。

Objective To summarize the clinical data and efficacy of surgical treatment of aortic periannular abscess. Methods The clinical data of 35 aortic periannular abscess patients admitted to our hospital from January 2009 to June 2019 were retrospectively analyzed, including 21 males and 14 females, aged 36 to 67(53.0±12.3) years. Among them, there were 14 patients of native aortic valve endocarditis and 21 patients of prosthetic valve endocarditis(16 patients of mechanical valve and 5 patients of biological valve). Preoperative blood cultures were positive in 15 patients, including 8 patients of Staphylococcus aureus, 2 patients of Staphylococcus epidermidis, 3 patients of Streptococcus grass green, 1 patient of Pseudomonas aeruginosa, and 1 patient of Enterococcus. Results Eleven patients underwent emergency or urgent surgery. Thirty patients underwent aortic valve replacement, and 5 patients underwent modified Cabrol surgery to replace the aortic root. Early postoperative complications included 1 patient of bleeding, 8 patients of low cardiac output syndrome, 5 patients of renal insufficiency, 10 patients of respiratory insufficiency, 3 patients of tracheotomy, 8 patients of pulmonary infection and 1 patient cerebrovascular accident. The postoperative follow-up period was 6 to 120(53.6±20.8)months. During the follow-up, 4 patients died and 4 patients were lost. No infection recurred during the follow-up.Perivalval leakage occurred in 3 patients, and one patient underwent occlusion 12 months following the procedure. The survival curve indicated that the 1-year survival rate was 85.5%, and the 5-year survival rate was 67.3%. Conclusion Although the lesions of periannular abscesses are complicated and critical, effective perioperative antibiotic treatment,individualized surgical timing, and appropriate surgical strategies can significantly reduce mortality and achieve better results.