主动脉全弓置换加硬“象鼻”术治疗DeBakey Ⅰ型主动脉夹层  

Total arch replacement combined with stented elephant trunk implantation for DeBakey Ⅰ aortic dissection

作　　者：吴红兵[1] 王志维[1] 毛志福[1] 刘朝兵[1] 胡小平[1] 

机构地区：[1]武汉大学人民医院心血管外科,430060

出　　处：《中华胸心血管外科杂志》2010年第3期158-160,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题为湖北省自然科学基金项目（2008CHB421）

摘　　要：目的总结主动脉全弓置换加硬“象鼻”术治疗DeBakeyⅠ型主动脉夹层的临床经验。方法2005年6月至2008年3月，手术治疗41例DeBakey Ⅰ型主动脉夹层病人，其中男32例、女9例；年龄27—76岁，平均57岁；急性主动脉夹层31例，慢性夹层10例。均在深低温停循环、低流量脑灌注下行主动脉全弓置换加硬“象鼻”手术。其中Bentall＋全弓＋硬象鼻术（术中支架系统直视下置入）24例，Wheat＋全弓＋象鼻术6例，升主动脉及全弓置换＋硬象鼻术11例。结果平均体外循环（1684-32）min，平均主动脉阻断（1094-24）min，选择性脑灌注（314-11）min。术后并发症14例（34．1％），12例治愈（85．8％），2例死亡。出院前均复查CT示升主动脉、主动脉弓部人工血管，术中支架系统血流通畅，位置良好，降主动脉真腔较术前明显扩大，未闭的降主动脉假腔血栓形成，无不良事件发生。随访1～12个月，死亡1例，无再次手术者。结论主动脉全弓置换加硬“象鼻”术是治疗DeBakeyⅠ型主动脉夹层安全、有效的方法。Objective It is controversial to the surgical treatment of the DeBakey I aortic dissection. The purpose of the study was to summarize the clinical experience on total arch replacement combined with implantation of stented elephant trunk into the descending aorta for DeBakeyⅠ aortic dissection. Methods From June 2005 to March 2008, 41 consecutive patients with acute（ in 31 ） or chronic （ in 10） DeBakey Ⅰ aortic dissection underwent total arch replacement combined with implantation of stented elephant trunk into the descending aorta. The mean age was 57 （ 27 - 76 ） years. Thirty-two patients were male. The procedure was performed under deep hypothermie circulatory arrest and selected cerebral perfusion. The stented elephant trunk was implanted through the aortic arch under deep hypothermic circulatory arrest. The stented elephant trunk was an 8 - 10 cm long self-expandable graft. Concomitant procedures included Bentall operation and total arch replacement in 24, Wheat operation and total arch replacement in 6, ascending aorta and total arch replacement in 11. Computed tomography was performed in every patient before discharge to evaluate the postoperative outcomes of the procedure. Results Cardiopulmonary bypass time was （ 168 ±32） min. The cross clamp time was （ 109 ±24） min and selective cerebral perfusion and the lowerbedy circulatory arrest time was （ 31 ± 11 ） min. The in-hospital mortality was 4.9 % （2/41）. One patient died of hemorrhagic shock and another died of multi-organ failure postoperatively. Fourteen eases suffered complications and 12 eases were cured. One ease died of the cerebral hemorrhage after 4 months due to inappropriate antieoagulation during follow up. Conclusion Ascending aorta and total aortic arch replacement combined with implantation of stented trunk into descending aorta is a safe, effective and feasible way in closing the residual false lumen of the descending aorta with a low morbidity and mortality. This procedure might contribute to a better long

关 键 词：主动脉 动脉瘤 夹层 人工血管 心脏外科手术 支架 

分 类 号：R654.3[医药卫生—外科学]