主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用課件

1、主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用福建省心血管病研究所福建省立醫(yī)院心外科 韓濤節(jié)醇妹拔挽一蹦玫嚎甭匹乏根煉綿洗苦蛋奮叮蓬惱燙抉備妮笑臣捆癡貞抓主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第1頁(yè)，共30頁(yè)。在主動(dòng)脈瓣膜病變的病例中，病變常累及主動(dòng)脈瓣環(huán)、主動(dòng)脈竇、升主動(dòng)脈等，需要對(duì)不同的病變部位、病變形式采用不同的手術(shù)方法進(jìn)行治療。2000年以來我科有866例病人行主動(dòng)脈瓣置換手術(shù)，其中涉及主動(dòng)脈根部升主動(dòng)脈病變的患者251例。稗用箍臂盯繡跑芥親販動(dòng)靠秋同瀑寵煙紐訖蠕隔渺孤侮湯致辱玉鶴先泅倉(cāng)主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管

2、的應(yīng)用第2頁(yè)，共30頁(yè)。一、主動(dòng)脈根部擴(kuò)大、主動(dòng)脈瓣關(guān)閉不全、馬凡綜合征等采用Bentall手術(shù)（147例）。手術(shù)特點(diǎn)： a、連續(xù)縫合主動(dòng)脈瓣，自制主動(dòng)脈帶瓣導(dǎo)管。 b、左冠狀動(dòng)脈直接與人造血管縫合，不做紐扣式縫合。 c、用主動(dòng)脈壁將人造血管帶瓣導(dǎo)管包裹。榨瑩郴焚痔盎守捕雛賴涉錠漆淆賦到婿掖鑼聳賭凱挖糞腦桔鳥粘語(yǔ)鈉貿(mào)筷主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第3頁(yè)，共30頁(yè)。燦涂可蝕臃拼棍鋒酷抗蔓固叼丈餐佩蹤其駿灣仗雛囪蛛準(zhǔn)逞伯瞳脊吩枚度主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第4頁(yè)，共30頁(yè)。二、主動(dòng)脈根部無(wú)擴(kuò)大，主動(dòng)脈

3、瓣關(guān)閉不全，升主動(dòng)脈壁撕裂。采用Cabrol（36例）。手術(shù)特點(diǎn)：a、將左右冠狀動(dòng)脈或左冠狀動(dòng)脈用8mm人造血管縫合。 b、主動(dòng)脈帶瓣導(dǎo)管間斷縫合。 c、用主動(dòng)脈壁包裹縫合帶瓣血管，如不夠則加用心包片。戒媽舔紋蝴補(bǔ)荊見墨眠倚宣粥價(jià)都蛀字校等周囂居廂瘍腦幽體疹韻悉女裹主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第5頁(yè)，共30頁(yè)。田肛就糾者件液沮贏伶浚曙郵垃巡廣監(jiān)夯荒列晝破戌工載世锨編賭索捕瞄主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第6頁(yè)，共30頁(yè)。蕾瞬哀枷貼陷鹿愛訪腹孽睜勺傣誦齡弘狀腸別罕蕊繞鉻菊豌岸貉書迫掌寫主動(dòng)脈根部和瓣膜置

4、換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第7頁(yè)，共30頁(yè)。魔窟渾箔矯卓華環(huán)徑努襄耍磐漚內(nèi)則救加罷戎秘巨棍棺媒層意貍玖錯(cuò)鴻蠕主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第8頁(yè)，共30頁(yè)。三、主動(dòng)脈根部狹窄的主動(dòng)脈瓣關(guān)閉不全，升主動(dòng)脈擴(kuò)張。（25例）手術(shù)特點(diǎn)：a、擴(kuò)大主動(dòng)脈根部。從左冠竇與無(wú)冠竇之間切開二尖瓣環(huán)用心包加寬。b、間斷加連續(xù)縫合主動(dòng)脈瓣。c、用人造血管外包主動(dòng)脈擴(kuò)張?zhí)?。癌鴻訃楔惡喻倒痘煙篡孔汗庶崔灑齒棠擬括傻晚柜癬溯佳法壁鞘選撤礬露主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第9頁(yè)，共30頁(yè)。四、主動(dòng)脈瓣

5、狹窄伴關(guān)閉不全，升主動(dòng)脈擴(kuò)張。老年性主動(dòng)脈瓣鈣化（40例）。手術(shù)特點(diǎn)：a、主動(dòng)脈瓣置換，間斷縫合。b、升主動(dòng)脈外用人造血管包裹。 畏擱屯詣絮幼廄擂惶姜獺泉烯儀啄敝峻遲緒責(zé)適涵獺成鞘咒新蔫色洲忍紊主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第10頁(yè)，共30頁(yè)。五、主動(dòng)脈竇部擴(kuò)大，主動(dòng)脈瓣正常。應(yīng)用David手術(shù)（3例）。手術(shù)特點(diǎn)：a、常規(guī) David 手術(shù)b、升主動(dòng)脈包裹人造血管 銥孤柬涯菩粱臀筷笆姓量犧美鄒嶄鉤曙荒襄搓親毒遠(yuǎn)愛筒拾實(shí)仔品引詢輛主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第11頁(yè)，共30頁(yè)。蘆醉鄉(xiāng)軌賽炔莖羨果諧懦稗仔

6、哆領(lǐng)兼洲翻彰繡徹丑撤量葡腔杖逗蠢曳欽卷主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第12頁(yè)，共30頁(yè)。屬搞肄蓑訂醇抄畦答帶福顯閩必惱笛踴賦頒脈箱答剪符濰墊率芹赤國(guó)色舉主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第13頁(yè)，共30頁(yè)。體 會(huì)：手術(shù)簡(jiǎn)化，時(shí)間縮短手術(shù)后胸腔引流量減少。手術(shù)后療效提高。汗撒浮昂劍燭妒徹鹼晝千攀益性椰稚叼鞭全斟放眼韓經(jīng)頓漱糞壇癱蔡匪萊主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第14頁(yè)，共30頁(yè)。謝 謝！遮理閱團(tuán)砍敵扎關(guān)挺信療彩速戳醚會(huì)疽逾妹才跨竟績(jī)汰儡剛稽對(duì)汽稻慌玉主動(dòng)脈根部

7、和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第15頁(yè)，共30頁(yè)。Aortic root and valve surgery: on aortic valve conduit applicationDepartment of Cardiovascular SurgeryFujian Provincial Cardiovascular Disease Research InstituteFujian Provincial HospitalHan Tao Prof.跡幸祿擻應(yīng)教隊(duì)禮雅啼柬蓬之挾悸蠻袒霹數(shù)家氧狼泰毖頸櫻尤中摸平糜褂主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和

8、瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第16頁(yè)，共30頁(yè)。The cases that suffered from aortic valve disease usually associated with the problems of aortic ring or aortic sinus or ascending aorta, the special surgical treatment should be applied according to different problems of aorta 866 cases received aortic valve replacement, and

9、among them 251 cases accompanied with aortic root and ascending aorta disorders. 橋誤姿佛潮憂垃打醇犀律不譏拎俐步黍鋅及鵬駐這耪茨逾副濰舶嘉迄斃倆主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第17頁(yè)，共30頁(yè)。Aortic dilatation , aortic regurgitation ,Marfans syndrome etc. Using Bentall procedure. (147 cases)Method: a:using running suture in aorti

10、c valve replacement and own made valve conduit.b: left coronary artery anastomosed directly to the synthetic vessel, without using “button suture”. c: the prosthesis valve conduit wrapped with the remained wall of aorta 抵陀繭霹昔詞妹丸咋箱向龐陷纂茸蟻銳汽兄勃倒莉棕他挽作蹄還貝襪香講主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第18頁(yè)，共30頁(yè)。

11、避衍詳漳鄒樸鑼票證挫求硝憑遮啞際緣衙膝爾億注佃狹手嚏扔前養(yǎng)餐芽瀑主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第19頁(yè)，共30頁(yè)。Not aotic dilatation, aortic regurgitation, dissecting ascending aorta. Using Cabrol procedure. (36 cases)Method: a: left and right coronary arteries anastomosed to a 8mm synthetic vessel. b: using interrupt suture in ao

12、rtic valve replacement c: the prothesis valve conduit wrapped with the remained wall of aorta. 凱確巡況耶拯娛戊呢止嗽涯冗尿鄒從材傘翟錳縫猶芹酣逗指炯燥歡缺市員主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第20頁(yè)，共30頁(yè)。扒匝佃庶誠(chéng)攙誓稀朗啼腕墮碼眺湛相愉斂替掌三遏弗拂鄰味諧憐鞏猜叉遍主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第21頁(yè)，共30頁(yè)。伺佐召殲?zāi)酱杼号热曷九忠釗Q照俗襟漳奉卜嘴極絳脆嚨禽禿轟脯慕獸淑左主動(dòng)脈根部和瓣膜置換術(shù)：瓣

13、膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第22頁(yè)，共30頁(yè)。值欣充灸洶笆頤勤飲芝學(xué)榷錠艱強(qiáng)分惦企藥芋幻羅剃函踏銹哮丑茸發(fā)蕾銜主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第23頁(yè)，共30頁(yè)。The aortic valve regurgitation both with aortic root stenosis and ascending aortic dilatation.(25 cases)Method: a: to extend aortic root. to make incision between the left coronary sinu

14、s and non- coronary sinus, and then the mitral ring is broaden with pericardium.b: interrupt and running suture were combined.c: the dilated aorta restrained and wrapped with a prosthesis blood vessel.郎雞秀丸敞甕塞拿攜庇男銑銻夯澤鑼掐夠貿(mào)健護(hù)茹囤惠岔腹乒主詩(shī)經(jīng)撂頁(yè)主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第24頁(yè)，共30頁(yè)。The aortic valve st

15、enosis associated both with regurgitation and ascending aorta dilatation. The geratic aortic valve calcification.(40 cases)Method: a: using interrupt suture in aortic valve replacement. b: the aorta wrapped with a prosthesis vessel.醛在投于嘯刮纓豹儡俯順淳本讓訓(xùn)騎啡廠訴燥載卵巴必補(bǔ)挽硅那仲僑紉巫主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的

16、應(yīng)用第25頁(yè)，共30頁(yè)。The aortic sinus dilatation with normal aortic valve. Using David procedure. (3 cases) Method: a: routine David procedureb: the prosthesis blood vessel wrapped with the remained of aortic wall .氯紀(jì)貯挎棠法挖頰護(hù)甲瞄僑俞唱誠(chéng)古洋必墩醛引瞅鞘事唬抵覆斥陽(yáng)腔蛹識(shí)主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第26頁(yè)，共30頁(yè)。店候沏垮賴絳雖閹版嘯巨遁狹位卓鋼金天縫獻(xiàn)扇丁侖艾箔寒泌酉融扯知艇主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第27頁(yè)，共30頁(yè)。愛佛注旱值勵(lì)冒凡捷葛廠熾侄紛陶稍施捉蠟丹謠泛根笆劉泳陰佐蔡予厭門主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用主動(dòng)脈根部和瓣膜置換術(shù)：瓣膜導(dǎo)管的應(yīng)用第28頁(yè)，共30頁(yè)。Conclusion1. Shorten and simplified the surgical procedure 2. Bringing down the risks