中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

保留自体头臂血管的孙氏手术在急性主动脉夹层中的应用

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目的 探索保留自体头臂血管的孙氏手术在治疗急性 Stanford A 型主动脉夹层中的手术技术要点及手术适应证。 方法 2011 年 8 月至 2013 年 10 月我院连续收治 28 例急性 Stanford A 型主动脉夹层患者,均腋动脉插管,中低温选择顺行性脑灌注下行两血管片法保留自体头臂血管的孙氏手术,其中男 23 例、女 5 例,年龄 29~62 (47±8) 岁。其中高血压病患者 26 例,马方综合征患者 2 例,同期行主动脉根部置换术(Bentall 术)4 例,Bentall+二尖瓣置换术(MVR) 1 例,主动脉窦成形 6 例。 结果 体外循环时间(167±35)min,主动脉阻断时间(80±22)min,选择性脑灌注时间 (29±5) min,本组住院死亡 1 例,主要死亡原因为术后急性肝衰竭;神经系统并发症 2 例,患者 1 周后延迟苏醒,经治疗后痊愈出院。患者出院前均行主动脉 CTA 检查,自体头臂动脉显影清晰,周围无造影剂外溢,降主动脉真腔较术前明显扩大,25 例患者支架段假腔完全血栓化,2 例出现内漏。对 27 例患者随访 47(36~62)个月:其中 1 例因胸腹主动脉扩张行全胸腹主动脉置换换术,1 例术后 2 年余因支架人工血管远端血管破裂急诊行主动脉腔内隔绝术。 结论 对于头臂动脉未受累及的急性 Stanford A 型主动脉夹层患者,保留自体头臂血管的孙氏手术安全有效,手术死亡及相关并发症发生率较低,近中期结果良好。

Objective To study surgical indication, technique for treating acute Stanford type A aortic dissection involving repair of the aortic arch using Sun’s procedure with preservation of autologous brachiocephalic artery. Methods We retrospectively analyzed the clinical data of 28 consecutive patients (23 males, 5 females) who underwent operations on acute Stanford type A aortic dissection using Sun’s procedure with preservation of autologous brachiocephalic artery in our hospital between August 2011 and October 2013. The mean age was 29-62 (47±8) years. There were 26 patients with hypertension and 2 patients with Mafan syndrome. Sun’s procedure with preservation of autologous brachiocephalic artery was performed in all patients, concomitant procedure included aortic root replacement (Bentall) in 4 patients, aortic root replacement (Bentall) and mitral valve replacement (MVR) in 1 patient, aortic valsalva sinus plasty in 6 patients. Results The cardiopulmonary bypass time was 167±37 min. The cross clamp time was 80±22 min. Selective cerebral perfusion time was 29±5 min. One patient died postoperatively from acute hepatic failure. Two patients suffered from transient neurologic deficit and recovered after treatment during follow-up. Computed tomography angiography (CTA) of aorta was performed in each patient before discharged from the hospital. The patency of the anastomotic site at brachiocephalic artery was identified. Descending aortic true lumen was significantly expanded. There was only 2 patients with endoleak and total thrombosis of false lumen was found near stent graft with 25 patients. The 27 patients were followed up for 47 (36-62) months. One patient with descending thoracic aortic dilatation underwent thoracoabdoninal aortic replacement. One combined with acute endometrial tear underwent thoracic endovascular aortic repair. Conclusion Sun’s procedure with preservation of autologous brachiocephalic artery is safe and effective in the treatment of acute Stanford type A dissection in patients without brachiocephalic artery involved. Low mortality and complication rate are achieved, but the long-term results need the further follow-up.

关键词: 主动脉夹层; 头臂动脉; 主动脉弓; 孙氏手术

Key words: Aortic dissection; brachiocephalic artery; aortic arch; Sun’s procedure

引用本文: 郭世超, 孙立忠, 陈雷, 齐瑞东, 朱俊明. 保留自体头臂血管的孙氏手术在急性主动脉夹层中的应用. 中国胸心血管外科临床杂志, 2018, 25(6): 512-515. doi: 10.7507/1007-4848.201706005 复制

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