猪腹股沟是什么位置 猪腹股沟在哪个位置图片

原创 Dr. Roland Fasol 广州富力医疗管理 2022-04-02 16:43

Mentioning the ‘plague’ of rheumatic heart disease for the population of China there is a significant percentage of patients affected by rheumatic heart valve problems requiring heart valve surgery. Hardly anyone knows this, and little is talked about this.

说到风湿性心脏病，中国患者可谓是饱受“折磨”，有很大比例的中国患者因风湿性心脏瓣膜病需要进行心脏瓣膜手术。这种状况鲜为人知，也很少被人谈及。

In 2018, the WHO declared RHD as a global health priority.

2018年，世界卫生组织宣布将风湿性心脏病列为全球卫生优先事项。

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The current options available for these rheumatic patients are somewhat limited. The majority of rheumatic heart valve patients are younger patients between 30 to 45 years of age.

Options of implanting a biological heart valve prosthesis are bad, since the younger the patients the faster biological heart valves degenerate and fail.

目前，风湿性心脏病患者的治疗方法十分有限。大多数风湿性心脏瓣膜病患者的年龄在 30-45 岁。

由于患者年龄越小，生物心脏瓣膜衰退和失效的速度越快，因此植入生物心脏瓣膜并非绝佳的方案。

Available Heart Valves:

现有的心脏瓣膜：

Mechanical

机械心脏瓣膜

Advantage 优点：

last lifelong

可终生使用

Disadvantage 缺点：

lifelong anticoagulation

thromboembolic&bleeding complications

click noise

需终生服用抗凝药

血栓和出血并发症

有噪声

Biological

生物心脏瓣膜

Advantage 优点：

no anticoagulation

no click noise

无需服用抗凝药

无噪声

Disadvantage 缺点：

limited lifetime

only elderly patients

使用寿命有限

仅限用于老年患者

Biopolymer

聚合物心脏瓣膜

Advantage 优点：

last lifelong

no anticoagulation

no click noise

可终生使用

无需服用抗凝药

无噪声

Disadvantage 缺点：

---

Biological TAVI

介入人工生物心脏瓣膜

Advantage 优点：

no anticoagulation

no click noise

no open heart surgery

无需服用抗凝药

无噪声

无需进行心脏直视手术

Disadvantage 缺点：

limited lifetime

only elderly patients

expensive

使用寿命有限

仅限用于高龄患者

价格高昂

Polymer TAVI

介入人工聚合物心脏瓣膜

Advantage 优点：

cheap and easy producable

last lifelong

no anticoagulation

no click noise

easy to implant

no degeneration

价格便宜，易生产

可终生使用

无噪声

易植入

无衰退

Disadvantage 缺点：

---

Currently there is no ‘ideal’ heart valve. The advantage of lifelong durability of mechanical heart valves is hampered by thromboembolic complications due to required lifelong anticoagulation.

Either bleeding (brain, nose, gastric or other hemorrhage) or thromboembolic complications occur with a frequency of 2 to 5% /a year (which means 20 to 50% in 10 years).

The mechanical ‘click’ may be clearly heard even in some distance of the patient and might drive some even crazy.

目前尚未发现“理想型”心脏瓣膜。由于需要终生抗凝，血栓栓塞并发症削弱了机械心脏瓣膜终生耐用的优点。

出血（脑、鼻、胃或其他部位出血）或血栓栓塞并发症的发生频率为每年 2%-5%（这意味着 10 年后并发症的发生频率可达 20% 至 50%）。

部分患者可能会清楚地听到机械心脏瓣膜发出的“咔哒”声而饱受困扰。

An explanted mechanical heart valve more or less completely occluded due to thrombus formation.因血栓引起完全闭塞而取出的机械心脏瓣膜。

A biological heart valve, explanted due to progressive leaflet degeneration and tear.

因进行性瓣叶退化和瓣膜撕裂而取出的生物心脏瓣膜。

The advantages of biological heart valves (made either of porcine or bovine tissue) include that they may not require anticoagulation, do not make any noise (no mechanical click) and allow a ‘normal’ life.

However, the durability is limited and in younger patients this may require re-operations after a short period of time. Reasons of failure of biological heart valves in younger patients are mainly due to leaflet calcification and subsequent tear or stenosis.

生物心脏瓣膜（猪心瓣膜或牛心包瓣膜）的优点：无需进行抗凝治疗，无噪声（无机械“咔哒”声），生活质量有所提高。

然而，其缺点包括：使用寿命有限，如植入在年轻患者体内，短期内可能需要再次手术。年轻患者生物心脏瓣膜衰败的原因主要是瓣叶钙化，撕裂或狭窄。

In recent years the development of Transcatheter Aortic Valve Implants (TAVI) opened new perspectives in interventional heart valve treatment strategies.

近年来，经导管主动脉瓣植入术 (TAVI) 的发展为心脏瓣膜病的介入治疗开辟了新前景。

What is such a TAVI ? How does it work ?

TAVI 是什么？手术效果如何？

This new generation of TAVI heart valves are biological valves that could be implanted using a catheter using access through the femoral artery (in the groin) or directly through the chest, in-between the ribs directly into the heart.

This catheter based technique allows to implant such valves without open heart surgery, without opening the (Sternum) - the front of the chest.

This new technique started with aortic valves, but now also mitral valves are available as TMVI implants. In countries like Germany now >70% of all aortic valve operations are done with TAVI valves.

新一代介入人工心脏瓣膜（TAVI)，经导管通过股动脉（腹股沟）或直接通过胸部，在肋骨间输送至心脏。

这种基于介入导管的技术可以实现在不进行心脏直视手术的情况下进行瓣膜植入，无需开胸。

该技术始用于主动脉瓣，目前也可用于二尖瓣。在德国等国家，超过70% 的主动脉瓣手术都通过使用介入人工心脏瓣膜完成的。

However, the durability of those biological TAVI valves are limited and only licensed for elderly patients and can not be used for younger patients.

然而，介入人工生物心脏瓣膜的使用寿命有限，而且仅供老年患者使用，不能用于年轻患者。

Summary:

Currently there is no ‘perfect’ or ‘ideal’ heart valve prosthesis available, and specially not for younger patients like the rheumatic heart valve patients we face in China.

小结：对于中国风湿性心脏瓣膜病的年轻患者来说，目前并没有“完美”或“理想”的心脏瓣膜存在。

What can we do ?

我们能做些什么？

We need a completely new heart valve concept for the future of cardiac surgery. We need to start the future now !

Current heart valve protheses, if mechanical or biological, have been developed long time ago (and have not really changed since then).

秉持全新的心脏瓣膜理念，开创心脏外科手术新纪元。从现在开始，开创未来！

目前的心脏瓣膜，无论是机械瓣膜，还是生物瓣膜，都是很久以前研发的（延续至今，未曾改变）。

The biggest development of the last years was the introduction of transcatheter aortic or mitral valve implants to allow a valve replacement with a catheter and without open heart surgery. This allows a fast recovery and a short hospital stay.

However, these TAVI valves use those bovine biological tissue with limited durability in the human organism and are expensive, about 3 to 4 times more expensive if compared to conventional heart valves.

近年来，随着经导管主动脉瓣和二尖瓣植入术的引进，实现了经导管进行瓣膜置换，无需进行心脏直视手术，恢复快，住院时间短。

然而，介入人工心脏瓣膜使用的是牛心包，使用寿命有限，且价格昂贵，与传统的心脏瓣膜相比，价格大约高出 3-4 倍。

We would need a heart valve concept that is cheaper and available (made robotically by 3D printing and not by manual work), easy to implant, no open heart surgery (but allows easy percutaneous implantation), does not degenerate and last for ever (or at least close to a life time), does not require anticoagulation (because heparin is covalently bound to the leaflet surfaces) and does not cause thromboembolic complications and will not require continuous life-long reliable anticoagulation.

我们需要一种价格更低、更容易获得的心脏瓣膜（通过 3D 打印机器人，非手工制作），易植入，无需进行心脏直视手术（便于经皮植入），不会衰败，可永久使用（接近终生），无需抗凝（因为肝素与瓣叶表面共价结合），不会引起血栓栓塞并发症。

The Future is Here !

未来已来！

The new heart valve concept has been realized, the first clinical study has met all of its primary endpoints at one year.

The novel Biopolymer valve, with a design intended to resist calcification, withstand stresses and strains without failure, and restore patient quality of life without requiring the lifelong use of anticoagulants proofed to be successful.

新型心脏瓣膜的概念已经成为现实，首次临床研究在一年内完成了所有既定目标。

新一代生物聚合物瓣膜的设计具有抗钙化、抗压力，零故障等特点，可提高患者生活质量，无需终生服用抗凝药物，效果良好。

The Novel Biopolymer

新型生物聚合物

The new SAT® Polyurethane heart valve, showing the transparent valve Leaflets.

● 新型SAT®聚氨酯心脏瓣膜，透明心脏瓣叶

The novel Foldex® TRIA biopolymer valve, shows excellent clinical results after 1 year of implantation in the first clinical study.

● 新型Foldex® TRIA生物聚合物心脏瓣膜，植入术后一年的一期临床实验显示效果良好

The 3D printer producing the new biopolymer heart valve.

● 3D 打印机正在制作新型生物聚合物心脏瓣膜

Picture clearly showing the new SAT® TAVI (percutaneous implantable) Polyurethane aortic heart valve (arrow), mounted collapsed on the introduction dilating balloon catheter.

安装在球囊扩张导管上的新型SAT®TAVI（经导管主动脉瓣植入术）聚氨酯主动脉瓣膜（箭头处）

Showing the new SAT® Polyurethane heart valve, mounted on a stent (right) and the introduction and dilating balloon catheter (on the left side).

安装在心脏支架（右侧）和球囊扩张导管（左侧）上的新型SAT®TAVI聚氨酯心脏瓣膜

This completely new heart valve concept was developed by Straight Access Technologies (SAT®) a spin-off start-up company of the University of Cape Town, South Africa.

全新的心脏瓣膜概念由南非开普敦大学的衍生初创公司 Straight Access Technologies (SAT®) 创造。

Summary:

If we could establish this future technology at the Guangzhou R&F Hospital our Heart and Cardiovascular Center could become one of the ‘Frontrunners’ for this novel heart valve concepts of the next generation in China and in all Asia.

小结：如广州富力医院引进这项未来技术，心脏和心血管卓越中心将成为中国乃至亚洲新一代新型心脏瓣膜概念的“先驱”之一。

The importance of these novel percutaneous and transcatheter valve implants is the fact that it will not degenerate like normal biological heart valves since it is produced with a completely newly designed Polyurethane. It will be cheap and easily available since produced robotically by 3D printing.

In contrast to mechanical heart valves it will be non-thrombogenic since covalently bound heparin covers the leaflet surfaces. In contrast to biological heart valves it will not degenerate and fail, because the biopolymer valve leaflets are not biological tissue and do not calcify and degenerate.

Furthermore, these novel valves can be implanted minimally invasive without major surgery through a percutaneous access.

新型经皮经导管瓣膜的重要性在于其全新设计的聚氨酯，不会像普通生物心脏瓣膜衰败。通过 3D 打印机器人生产，具有价格低廉，易购买等优点。

与机械心脏瓣膜相比，这种新型瓣膜不会形成血栓，因为共价结合肝素覆盖了心脏瓣叶表面。与生物心脏瓣膜相比，该新型瓣膜不会衰败和失效，由于生物聚合物瓣叶非生物组织，不会发生钙化和衰退。

不仅如此，该新型瓣膜可以通过经皮微创植入，免去大手术之苦。

Currently over 75% of all aortic valve operations in Germany are done using biological TAVI valve implants. However, the price range for this implant alone is currently above 20,000 to 25,000 US$ for one single valve.

Including preoperative diagnostics, hospital stay and surgery the total costs for such an operation in Europe are just quite expensive.

在德国，75% 以上的主动脉瓣手术都采用了介入生物心脏瓣膜。然而，目前单个瓣膜的费用需 2万 - 2.5万美元以上。

在欧洲，进行主动脉瓣手术产生的术前检查、住院和手术等费用十分高昂。

However, the main advantages of these new heart valves will be - in addition to be far cheaper and affordable due to robotically 3D printing production - that these valves will be suitable for younger patients and will allow a complication free valve implant that will have a long lifetime.

新型心脏瓣膜不仅价格亲民，适合年轻患者，而且还具有无并发症，使用寿命长的优点。

广州富力医院心脏和心血管卓越中心的潜力和前景

Potential and Outlook for our new Guangzhou R&F Hospital Heart and Cardiovascular Center.

If we at the Guangzhou R&F hospital Heart and Cardiovascular Center can establish this new technology, this would have a huge impact for our hospital and China. We could lower the price for an aortic valve procedure significantly, offer this procedure for an affordable price and increase the numbers of such procedures probably significantly.

若能引进这项新技术，将对我院乃至全国产生巨大影响，可显著降低主动脉瓣手术费用，以更亲民的价格为患者进行手术，从而令更多患者受益。

By offering a ‘quick and easy’ but also affordable high-tech and novel aortic valve replacement program for rheumatic patients for the country we could change the face of heart surgery quite significantly.

我们期待着，以先进的技术，合理的价格，为全国风湿性心脏病患者提供方便、快捷的新型主动脉瓣置换术方案，彻底改变传统心脏手术的面貌。

If we could realize this dream here at Guangzhou R&F hospital we could transform our hospital through a gigantic leap of development forward into the future and into completely new sky-high levels in modern cardiac medicine.

广州富力医院将始终致力于通过引进新技术，实现跨越式发展，迈向未来，迈向现代心脏病学新天地。

About the Author

作者介绍

广州富力医院CMO

Dr. Roland Fasol

罗兰夫医生 医学博士

奥地利维也纳大学 外科医生

德国弗赖堡大学 心脏外科医生

德国弗赖堡大学 博士后导师 特许任教资格

作为一位优秀的心血管外科医生，Dr. Fasol拥有着丰富精彩的人生履历。

1986年，他在柬泰边境爆发的柬埔寨丛林游击战中，担任国际红十字会战地医院的战地外科医生，救治过许多伤员。

Dr. Fasol深研成人心血管外科临床30年，独立完成各类介入手术8千余例，尤其擅长二尖瓣修补术、再次手术、疑难复杂心脏疾病手术等。他还成功实施了世界上第一例巴洛综合征（二尖瓣脱垂综合征）修复术。

Dr. Fasol还拥有多年构建现代医院的经验，包括从医疗团队的筹组，到医院运营规划、设备、IT、开发新的营销和患者信息解决方案、实施临床诊治标准等方方面面。

他先后在欧洲和亚洲多家医疗机构担任要职，其中包括：

- 在美国克利夫兰临床基金会和洲际酒店集团合营的一家奥地利私立心脏中心，担任项目创始人兼CEO；

- 在德国英戈尔施塔特私立医院，担任CMO兼心脏外科负责人；

- 在阿尔巴尼亚地拉那德国医院，担任CMO兼心脏外科负责人；

- 在中国长春吉林心脏病医院，担任心脏外科负责人；

- 在马尔代夫树顶医院，担任CMO兼心脏外科负责人；

- 在巴布亚新几内亚莫尔斯比港总医院，担任CMO兼心脏外科负责人。

Dr. Fasol数十年如一日，孜孜不倦地奋斗钻研、求索创新，分别在维也纳大学、开普敦大学和弗赖堡大学建立了多个基础研究实验室，均为第一批用于临床研究的组织工程和基因技术实验室。他先后获得24项国际奖项和多项研究资助，发表文章约300篇。