中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

改良全弓置换技术在 Stanford A 型主动脉夹层手术中的应用

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目的 应用改良全弓置换技术治疗 Stanford A 型主动脉夹层,通过评估其临床疗效来评价该技术的安全性及有效性。 方法 2015 年 6 月至 2016 年 12 月对连续 39 例 Stanford A 型主动脉夹层患者行改良全弓置换术,所有患者均在全身麻醉、浅低温停循环及双侧顺行性脑灌注下进行。根据主动脉根部病变情况采取相应术式:行 Bentall 术 4 例,David 术 2 例,主动脉瓣成形+升主动脉置换术 25 例,Cabrol 术 8 例;弓部处理均采用改良全弓置换+支架象鼻术;同期行二尖瓣成形术 1 例,三尖瓣成形术 1 例。 结果 全组体外循环时间(218.5±42.2)min,主动脉阻断时间(134.2±32.4)min,停循环时间(4.9±2.3)min,手术时间(415.5±80.5)min,术后透析 4 例,短暂性神经并发症 2 例,无永久性神经系统并发症,术后无截瘫,住院期间无死亡。全组患者出院前及出院后 3 个月复查心脏彩超及主动脉全程 CT。降主动脉假腔完全性血栓化 37 例,部分性血栓化 2 例。 结论 改良全弓置换技术治疗 Stanford A 型主动脉夹层是安全、有效的,可降低术后并发症发生率,近期疗效满意。

Objective To evaluate the safety and effectiveness of modified total arch replacement by retrospectively analyzing the clinical outcome of surgical patients with Stanford type A aortic dissection (AAD). Methods From June 2015 to December 2016, 39 consecutive patients with AAD were recruited to this study. This modified technique was preformed under general anesthesia and a 30℃ hypothermia circulatory arrest (HCA) with continual bilateral antegrade cerebral perfusion. Different surgical approaches were applied according to the aortic root condition: Bentall procedure (4 patients), David procedure (2 patients), aortic valve plasty and ascending aortic replacement (25 patients) and Cabrol procedure (8 patients). Concomitant procedures included mitral valve plasty (1 patient) and tricuspid valve plasty (1 patient). Results The average cardiopulmonary bypass (CPB), aortic occlusion time (ACC), HCA and operation time was 218.5±42.2 min, 134.2±32.4 min, 4.9±2.3 min and 415.5±80.5 min respectively. Four patients required dialysis and 2 patients developed temporary neurological deficit. No permanent neurological deficit, postoperative paraplegia or in-hospital death occurred. Computed tomography examination was performed on all patients before discharge and 3 months after discharge. The follow-up result showed that 37 patients developed complete thrombosis in the false lumen and 2 patients developed partial thrombosis. Conclusion Modified total arch replacement is a safe and effective approach for AAD. It can greatly avoid postoperative complications and provide satisfactory short-term outcomes.

关键词: 主动脉夹层; 外科治疗; 低温; 选择性脑灌注

Key words: Aortic dissection; surgery; hypothemia; selective cerebral perfusion

引用本文: 蔡诗豪, 范小平, 黄劲松, 彭继海, 张鸣生, 何杰, 许文柳. 改良全弓置换技术在 Stanford A 型主动脉夹层手术中的应用. 中国胸心血管外科临床杂志, 2018, 25(11): 962-966. doi: 10.7507/1007-4848.201803073 复制

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