| 胸骨上段小切口与胸骨正中切口行Bentall术的对比研究 | |
| Alternative Title | Comparison of Bentall procedure through Upper Hemisternotomy and Standard median sternotomy |
| 李俊玮 | |
| Subtype | 硕士 |
| Thesis Advisor | 柳德斌 |
| 2021-05-25 | |
| Degree Grantor | 兰州大学 |
| Place of Conferral | 兰州 |
| Degree Name | 医学硕士 |
| Degree Discipline | 外科学 |
| Keyword | 微创 Bentall手术 胸骨正中切口 胸骨上段小切口 |
| Abstract | 目的：比较经胸骨正中切口与胸骨上段小切口行Bentall手术的安全性及临床结果，通过回顾性分析两组患者术前，术中，术后临床资料的差异并分析可能原因，总结两组手术入路经验及优缺点，为本地区患者行Bentall手术提供一定的参考。 方法：收集我中心心脏外科自2017年12月至2020年9月期间收治并诊断为升主动脉瘤及主动脉根部扩张，并接受Bentall手术的患者，将符合纳入标准及排除标准的患者分为两组，一组为接受传统胸骨正中切口行Bentall术，一组为接受胸骨上段小切口行Bentall术，收集两组患者自围手术期至术后6月临床资料进行统计学分析，并总结归纳两组数据差异及原因。 结果：胸骨上段小切口组与胸骨正中切口组患者在术前检查及一般情况方面无差异，两组患者手术均顺利完成，术后左心室舒张末期容积均明显缩小，手术效果明确，且两组间术后心功能指标无差异(P＞0.05)。在主动脉阻断时间和体外循环辅助时间方面胸骨上段小切口组较胸骨正中切口组更长(P＜0.05)，但胸骨上段小切口组在术后24h引流量、血制品输注量方面较正中开胸组更少，术后住院天数方面较正中开胸组更短(P＜0.05)。两组患者在手术时间、ICU观察时间、机械辅助通气时间、术后并发症及住院费用等方面无明显差异(P＞0.05)。两组患者术后6月随访结果中术后心功能均有所好转，且两组间心功能指标无差异(P＞0.05)。 结论：经胸骨上段小切口与经胸骨正中切口入路两种手术入路行Bentall手术均可以取得良好的手术效果，胸骨上段小切口与胸骨正中切口相比，对患者的手术创伤更小，术后瘢痕小，术后恢复快，能够减少术后血制品使用量及胸腔引流量，缩短术后住院天数，但手术操作难度略增加，增加了体外循环时间。胸骨上段小切口入路在不增加手术风险的前提下可以使患者在术后恢复方面获益更多，两种术式应在仔细把握手术适应症的前提下，完善的影像学资料评估后根据患者的意愿与术者的经验进行综合选择。 |
| Other Abstract | Objective: To compare the safety and clinical results of Bentall procedurethrough median sternotomy and upper hemisternotomy. By retrospective analysis of the differences in preoperative, intraoperative and postoperative clinical data between the two groups and analysis of possible causes, summarize the experience, advantages and disadvantages of the two groups of surgical approach, and provide some reference for patients undergoing Bentall procedurein local area. Methods: The patients with ascending aortic aneurysm and aortic root dilatation who received Bentall procedurein the Department of Cardiac Surgery of our center from December2017 to September 2020 were collected. The patients who met the inclusion criteria and exclusion criteria were divided into two groups. One group received Bentall procedurethrough traditional median sternotomy and the other group received Bentall procedurethrough upper hemisternotomy. The clinical data of the two groups from perioperative period to 6months after operation were collected for statistical analysis, and the differences and causes between the two groups were summarized. Results: There was no significant difference in preoperative examination and general conditions between the two groups. The operation was successfully completed in both groups. The left ventricular end-diastolic volume was significantly reduced after operation. The surgical effect was clear. There was no significant difference in postoperative cardiac function indexes between the two groups (P >0.05). In terms of aortic cross-clamping time and cardiopulmonary bypass assistance time, the upper hemisternotomygroup had less median sternotomy incision (P <0.05), but the upper hemisternotomygroup had less postoperative 24h drainage volume and blood product transfusion volume than the median sternotomy group, and the postoperative hospital stay was shorter than the median sternotomy group (P <0.05). There was no significant difference in operation time, ICU observation time, mechanical assisted ventilation time, postoperative complications and hospitalization costs between the two groups (P >0.05). The postoperative cardiac function was improved in the follow-up results at 3 months after operation in both groups, and there was no difference in the cardiac function indicators between the two groups (P >0.05). Conclusion: Both upper hemisternotomyand median sternotomy can obtain good surgical results in Bentall procedure. Compared with median sternotomygroup, upper hemisternotomygroup has less surgical trauma, less postoperative scar and quick postoperative recovery, which can reduce the use of postoperative blood products and chest drainage volume and shorten the postoperative hospital stay, but the difficulty of surgical operation is slightly increased and the cardiopulmonary bypass time is increased. The small incision approach to the upper sternum can benefit the patients in terms of postoperative recovery without increasing the surgical risk. Under the premise of carefully grasping the surgical indications, the two methods should be comprehensively selected according to the patient's wishes and the surgeon's experience after perfect imaging data evaluation. |
| Pages | 48 |
| URL | 查看原文 |
| Language | 中文 |
| Document Type | 学位论文 |
| Identifier | https://ir.lzu.edu.cn/handle/262010/461516 |
| Collection | 第二临床医学院 |
| Affiliation | 第二临床医学院 |
| First Author Affilication | Second Clinical School |
| Recommended Citation GB/T 7714 | 李俊玮. 胸骨上段小切口与胸骨正中切口行Bentall术的对比研究[D]. 兰州. 兰州大学,2021. |
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