急性Stanford A型主动脉夹层的外科治疗  

Surgical treatment of acute type A aortic dissection

作　　者：董逸飞[1] 董书强[1] 李庆新[1] 尹强[2] 曹文峰[1] 宿华伟[1] 

机构地区：[1]兰州军区兰州总医院心血管外科,甘肃兰州730050 [2]兰州军区兰州总医院医教部,甘肃兰州730050

出　　处：《第四军医大学学报》2009年第8期710-712,共3页Journal of the Fourth Military Medical University

摘　　要：目的:总结急性A型主动脉夹层的外科治疗经验.方法:2003-01/2008-10手术治疗急性Stanford A型主动脉夹层17(男14,女3)例.年龄21～62(平均41.8)岁.采用深低温停循环(DHCA)加右腋动脉选择性脑灌注(ASCP)10例(59%),体外循环+DHCA3例(18%),中低温体外循环4例(23%).手术方式:升主动脉+全弓置换+降主动脉术中支架置入术7例,升主动脉+全弓置换2例,升主动脉+右半弓置换3例,升主动脉置换5例.结果:手术死亡2例(死亡率12%).生存的15例中,术后神经系统并发症4例(24%),心包积液2例(12%),胸腔积液4例(24%);肺部感染1例(6%),均治愈出院.随诊1mo～4a,无随诊期死亡.结论:急性Stanford A型夹层的患者应争取尽早采取手术,根据内膜破口位置、夹层的范围决定手术的范围和方式,熟练的手术操作、合适的体外循环和脑保护技术是手术成功的关键.AIM：To summarize the surgical experience for acute Stanford A aortic dissection. METHODS：From January 2003 to October 2008,17 patients with acute Stanford A aortic dissection underwent surgery. The age of the patients ranged from 21 to 62 with the average age of 41.8. The operations were performed by deep hypothermic circulatory arrest （DHCA） with antegrade selective cerebral perfusion （ASCP） in 10 cases （59%）,DHCA in 3 cases （18%）,and moderate hypothermic cardiopulmonary bypass in 4 cases （23%）. Surgical procedures included ascending and total arch grafting with stent elephant trunk technique in 7 cases,ascending and total arch grafting in 2 cases,ascending and hemiarch grafting in 3 cases,and ascending aortic grafting in 5 cases. RESULTS：The operative mortality was 12%. Neurocognitive deficits occurred in 4 cases （24%）. Fiveteen patients were followed up for 1 months to 4 years and no death occurred. CONCLUSION：Patients with acute Stanford A aortic dissection must be treated by operation at earliest time if possible. The choice of surgical procedures depends on the location of intimal tear and the range of dissection. The key points to achieve optimal results in acute Stanford A aortic dissection surgery include skilled surgical procedures,cardiopulmonary technique and brain protections.

关 键 词：主动脉瘤 动脉瘤 夹层 心脏外科手术 

分 类 号：R654.1[医药卫生—外科学]