支架象鼻技术对主动脉夹层的治疗效果  

Outcome of surgical repair with a stented elephant trunk for aortic dissection

作　　者：赵鑫[1] 常谦[1] 朱俊明[2] 刘永民[2] 于存涛[1] 郑军[2] 李滨[1] 孙立忠[2] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院心外科,北京100037 [2]首都医科大学附属北京安贞医院心外科,北京100029

出　　处：《山东大学学报（医学版）》2009年第10期91-93,共3页Journal of Shandong University:Health Sciences

摘　　要：目的评价应用全主动脉弓人工血管替换+改良支架象鼻的支撑型内衬远端吻合技术治疗主动脉夹层的临床效果。方法自2003年7月～2007年12月,应用全主动脉弓替换+支架象鼻技术治疗主动脉夹层94例,男80例,女14例,13～67岁,平均(44.45±9.41)岁。同期升主动脉行单纯置换55例,主动脉根部置换16例,主动脉瓣+升主动脉置换手术2例,窦部成形8例。结果全组平均体外循环(187.09±44.08)min,主动脉阻断(99.70±27.51)min,选择性脑灌注(22.47±11.35)min,术后2次开胸止血7例,肾功能衰竭2例,脑卒中1例,术后院内死亡2例;平均随访(34.86±18.08)个月,随访中死亡1例,有1例行胸腹主动脉Ⅱ期置换术,生存率为96.63%,患者出院1年后支架血管段假腔闭合效果好的占50.00%。结论应用全主动脉弓+结合支撑型内衬吻合技术的改良支架象鼻手术治疗主动脉夹层有良好的临床效果,主动脉CT能较好地跟踪评估残余假腔的闭合情况。Objective To evaluate the effect of a surgical approach for aortic dissection with a stented elephant trunk.Methods Between July 2003 and December 2007,a total of 94 patients,80 males and 14 female with aortic dissection underwent surgical repairs with a modified stented elephant trunk technique and total arch replacement.The sinus of the valsalva was reconstructed in 8 patients,aortic valve replacement was used in 18 patients,and ascending aorta replacement was performed in 81 patients.Results Average extracorporeal circulation time was（187.09±44.08）min,the aortic cross-clamp time was（99.70±27.51）min,the selected cerebral perfusion time was（22.47±11.35）min and the lower body arrest time was（20.87±8.86）min.Hospital mortality was 2.13%（2/94）.Mean time of follow-up was（34.86±18.08）months and the survival rate was 96.63%.Only one patient required re-operation for distal descending aorta replacement because of continuous false lumen extension.It accounted for 50% that diameter proportion between the stented graft and the aortic lumen at least one year post-surgery achieved more than 90%.Conclusion The modified stented elephant trunk anastomosis technique is an effective way for closing the residual false lumen of the descending aorta and may contribute to better long-term outcomes for aortic dissection.

关 键 词：主动脉夹层 象鼻技术 马凡氏综合征 

分 类 号：R654.3[医药卫生—外科学]