中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

Stanford A 型主动脉夹层累及冠状动脉的外科治疗

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目的 探讨 Stanford A 型主动脉夹层累及冠状动脉的外科治疗方法。 方法 回顾性分析 2009 年 1 月至 2016 年 12 月我院 56 例 Stanford A 型主动脉夹层累及冠状动脉并行外科手术患者的临床资料,其中男 39 例、女 17 例,年龄 26~73(51.36±16.47)岁。 结果 右冠状动脉受累 48 例,左冠状动脉受累 5 例,左右冠状动脉均受累及 3 例。术中 12 例行冠状动脉旁路移植术,19 例行 Cabrol 术,25 例行冠状动脉开口成形术。全组患者院内死亡 12 例(21.4%),术后生存 44 例,术后随访 3 个月至 3 年。随访期间无心血管不良事件发生。 结论 Stanford A 型主动脉夹层一旦累及冠状动脉病死率较高,外科手术同期对病变冠状动脉进行积极有效的手术治疗对于挽救此类患者十分重要;重建血运的方法需要视具体病情、外科医师经验而综合决定。

Objective To investigate the surgical treatment and results of coronary malperfusion due to acute Stanford A aortic dissection. Methods The clinical data of 56 patients with coronary malperfusion due to type A aortic dissection, who were hospitalized and underwent operation between January 2009 and December 2016, were analyzed retrospectively. There were 39 males and 17 females at age of 26–73 (51.36±16.47) years. Results The right coronary artery was involved in 48 patients, the left in 5 patients, and both coronary arteries in 3 patients. There were 12 patients with coronary bypass grafting, 19 patients with Cabrol’s operation, 25 patients coronary artery plasty. Twelve patients died postoperatively at mortality of 21.4%. Forty-four patients survived. The patients were followed up for 3 months to 3 years. No adverse event of cardiovascular happened. Conclusion Stanford A aortic dissection with coronary involvement is associated with high mortality rate.Aggressive coronary revascularization is essential to salvage these critically ill patients. The method to reconstruct the involved coronary depends on the patients’ condition and experience of surgeon.

关键词: 主动脉夹层; 冠状动脉; 外科治疗

Key words: Aortic dissection; coronary artery; surgical treatment

引用本文: 崔聪, 张力, 高夏, 肖长波, 卢伟, 武刚, 王平凡. Stanford A 型主动脉夹层累及冠状动脉的外科治疗. 中国胸心血管外科临床杂志, 2017, 24(12): 932-936. doi: 10.7507/1007-4848.20160705 复制

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