“杂交手术”在DeBakeyⅠ型主动脉夹层治疗中的应用及价值  

Thoracic aortic replacement with concomitant endoluminal stent grafting for DeBakey type Ⅰ aortic dissection

作　　者：张本[1] 张卫达[1] 王晓武[1] 王晓莉[1] 李杰[1] 

机构地区：[1]广州军区广州总医院,广东广州510010

出　　处：《南方医科大学学报》2010年第12期2725-2728,共4页Journal of Southern Medical University

基　　金：中国人民解放军总后勤部临床高新技术重大专项课题(2010gxjs031)

摘　　要：目的总结"杂交手术"(人工血管置换同期行远端顺行置入血管内支架)治疗DeBakeyⅠ型主动脉夹层患者的治疗体会及应用价值。方法 2007年9月至2010年1月,6例DeBakeyⅠ型主动脉夹层患者行升主动脉置换(或Bentall术)并全弓置换加降主动脉支架置入术(1例为二次手术)。术后定期复查胸部多排CT及CT血管造影,了解升主动脉、主动脉弓人工血管及降主动脉血管内支架情况。6例均采用深低温停循环选择性顺行性脑灌注。结果 6例患者均手术成功,无严重并发症,体外循环时间208～291min(平均242min),升主动脉阻断112～194min(平均145min),深低温停循环选择性脑灌注时间63～102min(平均76min),所有患者均顺利出院。随访时间为4～32月(平均15.5月),CT示人工血管通畅,支架段假腔完全血栓化,血管内支架无内瘘及移位,远端假腔明显缩小。结论对于DeBakeyⅠ型主动脉夹层行动脉瘤切除,人工血管置换(全弓)同期行顺行远端降主动脉支架置入,是一种安全、有效的手术方法。Objective To evaluate the therapeutic effect and safety of thoracic aortic replacement with concomitant endoluminal stent grafting in the treatment of DeBakey type Ⅰ aortic dissection. Methods From September 2007 to January 2010,6 patients with DeBakey type Ⅰ aortic dissection （including one with aortic dissection relapse） received ascending aortic （or Bentall） and total aortic arch replacement and simultaneous stent graft implantation into the descending aorta. Multi-slice spiral CT scans （MSCT） were performed in each patient regularly after the surgery. Cardio-pulmonary bypass including deep hypothermic circulatory arrest with selective antegrade cerebral perfusion were used during the surgery. Results All the patients recovered smoothly after the surgical procedure without serious complications. The time of cardiopulmonary bypass ranged from 208 to 291 min （mean 242 min）,arrest time of the ascending aortic was 112-194 min （mean 145 min）,and selective cerebral perfusion time was 63-102 min （mean 76 min）. The patients were followed up for 4-32 months （mean 15.5 months）,and MSCT revealed smooth blood flow in the prosthesis,complete thrombus formation in the false lumen in the perigraft space and shrinkage of the distal false lumen without internal fistula or stent dislocation. Conclusion Thoracic aortic replacement with concomitant endoluminal stent grafting is a safe and effective treatment of DeBakey type I dissection.

关 键 词：DeBakeyⅠ型主动脉夹层 人工血管 心脏外科手术 杂交技术 

分 类 号：R654.3[医药卫生—外科学]