支架象鼻技术对主动脉夹层的治疗效果

山东大学学报(医学版) ›› 2009, Vol. 47 ›› Issue (10): 91-93.

支架象鼻技术对主动脉夹层的治疗效果

赵鑫¹，常谦¹，朱俊明²，刘永民²，于存涛¹，郑军²，李滨¹，孙立忠²

1. 北京协和医学院中国医学科学院阜外心血管病医院心外科，北京 100037；2. 首都医科大学附属北京安贞医院心外科，北京 100029

收稿日期:2009-05-05 出版日期:2009-10-16 发布日期:2009-10-16
通讯作者: 孙立忠（1960- ），男，主任医师，博士，主要从事主动脉外科治疗的研究。 Email:f1paul@126.com
作者简介:赵鑫（1980- ），男，博士研究生，主要从事急性主动脉夹层治疗的研究。

Outcome of surgical repair with a stented elephant 
trunk for aortic dissection

ZHAO Xin¹, CHANG Qian¹, ZHU Junming², LIU Yongmin², YU Cuntao¹, ZHENG Jun², LI Bin1, SUN Lizhong2

1. Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, CAMS, Beijing 100037, China; 
2. Department of Cardiovascular Surgery, Beijing Anzhen Hospita, Capital University of Medical Sciences, Beijing 100029, China

Received:2009-05-05 Online:2009-10-16 Published:2009-10-16

摘要/Abstract

摘要：

目的评价应用全主动脉弓人工血管替换+改良支架象鼻的支撑型内衬远端吻合技术治疗主动脉夹层的临床效果。方法自2003年7月～2007年12月，应用全主动脉弓替换+支架象鼻技术治疗主动脉夹层94例，男80例，女14例，13～67岁，平均(44.45±9.41)岁。同期升主动脉行单纯置换55例，主动脉根部置换16例，主动脉瓣+升主动脉置换手术2例,窦部成形8例。结果全组平均体外循环（187.09±44.08）min，主动脉阻断（99.70±27.51）min，选择性脑灌注（22.47±11.35）min，术后2次开胸止血7例，肾功能衰竭2例，脑卒中1例，术后院内死亡2例；平均随访（34.86±18.08）个月，随访中死亡1例，有1例行胸腹主动脉Ⅱ期置换术，生存率为96.63%，患者出院1年后支架血管段假腔闭合效果好的占50.00%。结论应用全主动脉弓+结合支撑型内衬吻合技术的改良支架象鼻手术治疗主动脉夹层有良好的临床效果，主动脉CT能较好地跟踪评估残余假腔的闭合情况。

关键词: 主动脉夹层, 象鼻技术, 马凡氏综合征

Abstract:

To evaluate the effect of a surgical approach for aortic dissection with a stented elephant trunk. MethodsBetween July 2003 and December 2007, a total of 94 patients, 80 males and 14 female with aortic dissection underwent surgical repairs with a modified stented elephant trunk technique and total arch replacement． The sinus of the valsalva was reconstructed in 8 patients, aortic valve replacement was used in 18 patients, and ascending aorta replacement was performed in 81 patients. ResultsAverage extracorporeal circulation time was (187.09±44.08) min, the aortic crossclamp time was (99.70±27.51) min， the selected cerebral perfusion time was (22.47±11.35) min and the lower body arrest time was (20.87±8.86)min. Hospital mortality was 2.13％(2／94). Mean time of followup was (34.86±18.08) months and the survival rate was 96.63%. Only one patient required reoperation for distal descending aorta replacement because of continuous false lumen extension. It accounted for 50% that diameter proportion between the stented graft and the aortic lumen at least one year postsurgery achieved more than 90%. ConclusionThe modified stented elephant trunk anastomosis technique is an effective way for closing the residual false lumen of the descending aorta and may contribute to better longterm outcomes for aortic dissection.

Key words: ortic dissection; Elephant trunk technique; Marfan

中图分类号:

R654.3

. 支架象鼻技术对主动脉夹层的治疗效果[J]. 山东大学学报(医学版), 2009, 47(10): 91-93.

参考文献

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