中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

Cabrol 手术治疗 Stanford A 型主动脉夹层的疗效评价

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目的 探讨应用 Cabrol 手术治疗 Stanford A 型主动脉夹层的效果。 方法 回顾性分析我院在 2013 年 1 月至 2018 年 1 月接收确诊为 Stanford A 型主动脉夹层的患者临床资料,40 例患者行 Cabrol 手术,其中男 31 例、女 9 例,年龄 26~75(48.8±3.3)岁,对患者的手术治疗效果进行评价,主要是评价手术效果、手术前后患者心功能变化及术后随访情况。 结果 40 例手术患者均顺利完成手术;术后患者升主动脉直径、主动脉窦部直径均比术前要低(P<0.05);术后患者左心射血分数、心输出量均升高,中心静脉压下降,左心室舒张末期内径缩小,心功能指标同术前相比差异显著(P<0.05);手术死亡 2 例,术后随访患者出现 7 例并发症,其中 1 例支架内漏、3 例神经系统疾病、3 例急性肾功能衰竭。 结论 应用 Cabrol 手术治疗 Stanford A 型主动脉夹层的疗效显著,简化冠脉开口的吻合,减少手术出血,可明显改善患者心功能。

Objective To discuss the effect of Cabrol in the treatment of Stanford type A aortic dissection. Methods The clinical data of patients whom were diagnosed with type A aortic dissection of Stanford in our hospital from January 2013 to January 2018 were retrospectively analyzed. All of 40 patients underwent Cabrol surgical procedure. There were 31 males and 9 females aged 26–75 (48.8±3.3) years. The surgical treatment effect of the patients was evaluated, mainly including the evaluation of the surgical effect, the changes in cardiac function before and after operation, and the postoperative follow-up. Results All the 40 patients completed the operation successfully. The diameter of ascending aorta and aortic sinus in postoperative patients were lower than those before operation (P<0.05). Postoperative left ventricular ejection fraction and cardiac output were increased, central venous pressure and left ventricular end-diastolic dimension decreased, and cardiac function indexes were significantly different from those before the operation (P<0.05). Seven patients suffered complications in postoperative follow-up including one stenting leakage, three neurological diseases and three acute renal failure. Two (5.0%) patients died postoperatively. Conclusion Cabrol’s operation is effective in the treatment of Stanford type A aortic dissection, which can significantly improve the cardiac function of patients, simplify the anastomosis of coronary artery ostial and decrease amount of bleeding.

关键词: Cabrol 手术; Stanford A 型主动脉夹层; 疗效评价

Key words: Cabrol’s operation; Stanford type A aortic dissection; effect evaluation

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1. Patel HJ, Deeb GM. Ascending and arch aorta: pathology, natural history, and treatment. Circulation, 2008, 118(2): 188-195.
2. Ohlmann P, Faure A, Morel O, et al. Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection. Crit Care Med, 2006, 34(5): 1358-1364.
3. Golledge J, Eagle KA. Acute aortic dissection. Lancet, 2008, 372(9632): 55-66.
4. Isselbacher EM. Epidemiology of thoracic aortic aneurysms, aortic dissection, intramular hematnma, and penetrating atherosclerotic ulcers. Baliga RR, Nienaber CA, lsselbacher EM, et al, ed. Aortic Dissection and Related Syndromes. New York: Springer Science, 2007. 3-15.
5. Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection. Ageing Res Rev, 2009, 8: 31-35.
6. Sun L, Qi R, Chang Q, et al. Surgery for marfan patients with acute type a dissection using a stented elephant trunk procedure. Ann Thorac Surg, 2008, 86(6): 1821-1825.
7. 李滨, 孙立忠, 常谦, 等. 全弓替换加支架象鼻技术治疗复杂 Standford B 型主动脉夹层的临床观察. 中华医学杂志, 2010, 90(5): 323-326.
8. Sun L, Zhao X, Chang Q, et al. Repair of chronic type B dissection with aortic arch involvement using a stented elephant trunk procedure. Ann Thorac Surg, 2010, 90(1): 95-100.
9. Zhao HP, Zhu JM, Ma WG, et al. Total arch replacement with stented elephant trunk technique for acute type B aortic dissection involving the aortic arch. Ann Thorac Surg, 2012, 93(5): 1517-1522.
10. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
11. 庞锋, 陈兴澎. 支架象鼻开窗简化手术在治疗急性 Stanford A 型主动脉夹层中的临床分析. 中国心血管病研究, 2017, 15(11): 999-1001.
12. 孙祥飞, 孙文宇, 霍玉峰, 等. 改良 Y 型人工血管技术治疗急性 Stanford A 型主动脉夹层的短期疗效观察. 世界最新医学信息文摘, 2018, 18(16): 77-178, 180.
13. 吴怡锦, 熊卫萍, 曾嵘, 等. 孙氏手术治疗急、慢性 Stanford A 型主动脉夹层疗效的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 401-405.
14. 程凤, 陈庆良, 姜楠, 等. 孙氏手术与三分支主动脉弓覆膜支架治疗 Stanford A 型主动脉夹层的效果比较. 天津医药, 2016, 44(8): 951-954.
15. 熊师, 公兵, 田聪聪, 等. 三分支支架治疗急性 Stanford A 型主动脉夹层疗效的临床研究. 中国循环杂志, 2017, 32(s1): 147.
16. 潘俊, 宣煜龙, 陈小芳, 等. 孙氏手术治疗急性 Stanford A 型主动脉夹层. 中华胸心血管外科杂志, 2015, 31(6): 333-335.
17. 吴玉辉, 江蕊, 江磊, 等. 88 例 Stanford A 型主动脉夹层外科治疗效果. 临床军医杂志, 2017, 24(11): 1149-1152.
18. 李欣, 范瑞新, 张洪宇, 等. Cabrol 手术应用于 Stanford A 型主动脉夹层的疗效分析. 中国胸心血管外科临床杂志, 2015, 22(3): 198-201.
19. Ghazy T, Eraqi M, Mahlmann A, et al. Quality of life after surgery for Stanford type A aortic dissection: influences of different operative strategies. Heart Surg Forum, 2017, 20(3): E102-E106.
20. Cheng Y, Jin M, Dong X, et al. Mechanism and early intervention research on ALI during emergence surgery of Stanford type-A AAD: Study protocol for a prospective, double-blind, clinical trial. Medicine (Baltimore), 2016, 95(42): e5164.