“半兜状”自体心包片吻合技术治疗左冠状动脉开口较低且合并主动脉瓣病变的升主动脉瘤_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

魏庆彬 ,  李刚 , 谢飞 , 王士礼

哈尔滨医科大学附属第二医院心外科（哈尔滨 150086）;

Corresponding author：

李刚, Email: gangli73@163.com

Keywords：

升主动脉瘤; Bentall 术; 冠状动脉移植; 自体心包片

DOI：

10.7507/1007-4848.201704013

Video：

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目的探讨在冠状动脉移植时应用“半兜状”自体心包片吻合技术治疗左冠状动脉开口较低且合并主动脉瓣病变的升主动脉瘤的临床效果。方法回顾性分析我院心外二科 2012 年 11 月至 2016 年 1 月应用“半兜状”自体心包片吻合技术治疗 7 例左冠状动脉开口较低行 Bentall 术患者的临床资料，其中男 5 例、女 2 例，年龄（45.2±3.1）岁，术前主动脉 CT 血管造影（CTA）提示升主动脉瘤样扩张，直径（6.8±0.8） cm，合并主动脉瓣重度狭窄 2 例，余 5 例主动脉瓣中-重度关闭不全。手术在常规 Bentall 术式的基础上对左冠状动脉移植进行改良。应用自体心包片修剪成梭形，使之呈“半兜状” 兜住左冠状动脉开口下缘，将左冠状动脉开口上缘与人工血管打孔处上缘直接缝合，完成左冠状动脉移植。结果全组无死亡病例，体外循环时间（168.0±38.2）min，其中主动脉阻断时间（98.0±28.1） min。术后 24 h 引流量（575.0±65.0）ml。出院前复查心电图及心肌酶学指标（血清肌钙蛋白I、肌酸激酶同工酶、肌酸激酶）均正常。出院随访左室舒张期末内径与术前差异有统计学意义［（5.4±0.5）cm vs.（7.0±0.6）cm，P<0.001］。结论本技术手术操作相对简单、吻合方便、吻合口张力较小、出血风险小、止血方便。冠状动脉吻合口无扭曲及牵拉，不影响冠状动脉血流。术后患者心功能恢复良好，取得了良好的早、中期效果。

Citation： 魏庆彬, 李刚, 谢飞, 王士礼. “半兜状”自体心包片吻合技术治疗左冠状动脉开口较低且合并主动脉瓣病变的升主动脉瘤. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 445-448. doi: 10.7507/1007-4848.201704013 Copy

1.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
2.	David TE. Surgical treatment of ascending aorta and aortic root aneurysms. Prog Cardiovasc Dis, 2010, 52(5): 438-444.
3.	Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
4.	Etz CD, Bischoff MS, Bodian C, et al. The Bentall procedure: is it the gold standard? A series of 597 consecutive cases. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S64-S70.
5.	Gelsomino S, Morocutti G, Frassani R, et al. Long-term results of Bentall composite aortic root replacement for ascending aortic aneurysms and dissections. Chest, 2003, 124(3): 984-988.
6.	Manenti A, Zizzo M, Fedeli C, et al. Coronary Artery Pseudoaneurysm After Bentall Procedure. Ann Thorac Surg, 2016, 102(4): 1409.
7.	Benke K, Ágg B, Szabó L, et al. Bentall procedure: quarter century of clinical experiences of a single surgeon. J Cardiothorac Surg, 2016, 11: 19.
8.	Ziganshin BA, Williams FE, Tranquilli M, et al. Midterm experience with modified Cabrol procedure: safe and durable for complex aortic root replacement. J Thorac Cardiovasc Surg, 2014, 147(4): 1233-1239.
9.	Witzenbichler B, Schwimmbeck P, Schultheiss HP. Images in cardiovascular medicine. Myocardial infarction caused by occlusion of Cabrol conduit graft. Circulation, 2005, 112(6): e79-e80.
10.	Kim TS, Na CY, Oh SS, et al. Long-term mortality and morbidity after button Bentall operation. J Card Surg, 2013, 28(3): 280-284.
11.	杭永斌, 李刚, 王树伟, 等. 新鲜自体心包片移植在心血管外科中的临床应用. 中国胸心血管外科临床杂志, 2016, 23(9): 885-888.

1. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
2. David TE. Surgical treatment of ascending aorta and aortic root aneurysms. Prog Cardiovasc Dis, 2010, 52(5): 438-444.
3. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
4. Etz CD, Bischoff MS, Bodian C, et al. The Bentall procedure: is it the gold standard? A series of 597 consecutive cases. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S64-S70.
5. Gelsomino S, Morocutti G, Frassani R, et al. Long-term results of Bentall composite aortic root replacement for ascending aortic aneurysms and dissections. Chest, 2003, 124(3): 984-988.
6. Manenti A, Zizzo M, Fedeli C, et al. Coronary Artery Pseudoaneurysm After Bentall Procedure. Ann Thorac Surg, 2016, 102(4): 1409.
7. Benke K, Ágg B, Szabó L, et al. Bentall procedure: quarter century of clinical experiences of a single surgeon. J Cardiothorac Surg, 2016, 11: 19.
8. Ziganshin BA, Williams FE, Tranquilli M, et al. Midterm experience with modified Cabrol procedure: safe and durable for complex aortic root replacement. J Thorac Cardiovasc Surg, 2014, 147(4): 1233-1239.
9. Witzenbichler B, Schwimmbeck P, Schultheiss HP. Images in cardiovascular medicine. Myocardial infarction caused by occlusion of Cabrol conduit graft. Circulation, 2005, 112(6): e79-e80.
10. Kim TS, Na CY, Oh SS, et al. Long-term mortality and morbidity after button Bentall operation. J Card Surg, 2013, 28(3): 280-284.
11. 杭永斌, 李刚, 王树伟, 等. 新鲜自体心包片移植在心血管外科中的临床应用. 中国胸心血管外科临床杂志, 2016, 23(9): 885-888.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

“半兜状”自体心包片吻合技术治疗左冠状动脉开口较低且合并主动脉瓣病变的升主动脉瘤

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