Stanford A型主动脉夹层的外科治疗

山东大学学报(医学版) ›› 2011, Vol. 49 ›› Issue (1): 71-.

Stanford A型主动脉夹层的外科治疗

孙永辉，邹承伟，李德才，李红昕，王正军，訾捷，张文龙，张海洲，范全心，王安彪

山东大学附属省立医院心脏外科，济南 250021

收稿日期:2010-07-23 出版日期:2011-01-10 发布日期:2011-01-10
通讯作者: 王安彪（1966- ），男，主任医师，主要从事心血管疾病的外科治疗。 E-mail:abwang0607@sina.com
作者简介:孙永辉（1983- ），男，硕士研究生，主要从事大动脉疾病外科治疗的研究。
基金资助:
山东省自然科学基金资助项目（Y2005C26）；国家自然科学基金资助项目（30971676）。

Surgical treatment of Stanford type A aortic dissection

SUN Yong-hui, ZOU Cheng-wei, LI De-cai, LI Hong-xin, WANG Zheng-jun, ZI Jie, ZHANG Wen-long, ZHANG Hai-zhou, FAN Quan-xin, WANG An-biao

Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China

Received:2010-07-23 Online:2011-01-10 Published:2011-01-10

摘要/Abstract

摘要：

目的总结65例主动脉夹层的外科治疗经验，探讨治疗A型主动脉夹层的手术方式。方法 2003年9月～2010年4月共收治65例A型主动脉夹层患者。术中根据主动脉内膜破口的位置、夹层累及的范围、是否合并主动瓣关闭不全选择不同的手术方式，其中10例行单纯主动脉置换，13例行升主动脉+主动脉弓或半弓人工血管置换，27例行升主动脉+主动脉全弓或半弓人工血管置换+降主动脉支架象鼻术，7例行升主动脉置换+4分支人工血管支架象鼻术，8例行单纯Bentall手术，同期进行的手术包括冠状动脉旁路移植术4例，主动脉瓣成形术12例，主动脉瓣置换术8例，Bentall手术6例，涉及弓部置换者均采用深低温停循环选择性脑灌注。结果接受手术治疗者术中体外循环时间为86～350min，平均（188.3±60.9）min；主动脉阻断时间60～248min，平均（101.1±40.0）min；深低温停循环选择性脑灌注20～120min，平均（53.9±24.3）min。术后早期患者死亡2例，其中1例死于低心排出量综合征，1例死于肾功能衰竭。ICU滞留时间为1～63d，平均（4.2±8.8）d；住院时间13～106d,平均（24.8±13.8）d。术后并发运动功能失语1例、脑栓塞1例、肺部感染3例、肾功能不全1例、出血5例、精神障碍4例、气管切开1例、声音嘶哑1例。结论主动脉夹层分离病情凶险，但积极的早期外科治疗效果满意，快速准确的诊断和合适的手术方案是主动脉夹层手术成败的关键。

关键词: 主动脉夹层；Stanford A型；外科治疗；支架象鼻术

Abstract:

Objective To review surgical treatment of type A aortic dissection in 65 patients and to investigate the effectiveness of surgical approaches. Methods Between September, 2003 and April, 2010, 65 patients, including 45 males and 20 females from 26 to 58 (mean 41.6 ± 9.5) years old, with Stanford type A aortic dissection underwent surgical treatment. Different surgical approaches were adopted according to the rupture site, extent of dissection and aortic valvular insufficiency, including ascending aorta replacement only (10 cases), ascending aorta replacement + arch or semi-arch replacement (13 cases), ascending aorta replacement + arch or semi-arch replacement with stented elephant trunk (27 cases), ascending aorta replacement + four branches covered stent graft implantation (7 cases) and Bentall operation only (8 cases). Concomitant procedures were coronary artery bypass grafting (4 cases), aortic valvuloplasty(12 cases), aortic valve replacement(8 cases ) or Bentall operation (6 cases). Deep hypothermic circulation arrest with selective cerebral perfusion was employed in cases of aortic arch replacement and/or endovascular stent repair. Results In the operations, the CPB, clamp and circulation arrest time were 86 -350 (188.3±60.9), 60-248 (101.1±40.0) and 20-120 (53.9±24.3) minutes, respectively. There were two deaths early after operation. Onedied from low cardiac output syndrome and the other died from renal failure. Postoperative intensive care stay was 1~63 (4.2±8.8) days and the hospital stay was 13~106 (24.8±13.8) days. Complications consisted of motor aphasia(n=1), cerebral embolism(n=1), pulmonary infection(n=3), renal failure(n=1), hemorrhage(n=5), mental disorder(n=4), tracheotomy (n=1), and voice hoarseness(n=1). Conclusion Aortic dissection is the most common catastrophic event that involves the aorta, however, the prospects of early surgical treatment are satisfying. The key points are quick, correct diagnosis and proper surgical approaches.

Key words: Aortic dissection; Stanford type A; Surgical treatment; Stented elephant trunk technique

中图分类号:

R654.2

孙永辉，邹承伟，李德才，李红昕，王正军，訾捷，张文龙，张海洲，范全心，王安彪. Stanford A型主动脉夹层的外科治疗[J]. 山东大学学报(医学版), 2011, 49(1): 71-.

SUN Yong-hui, ZOU Cheng-wei, LI De-cai, LI Hong-xin, WANG Zheng-jun, ZI Jie, ZHANG Wen-long, ZHANG Hai-zhou, FAN Quan-xin, WANG An-biao. Surgical treatment of Stanford type A aortic dissection[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2011, 49(1): 71-.

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