改良全弓置换加支架象鼻术在DeBakeyI型主动脉夹层术中的应用  

The clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey Ⅰ thoracic aortic dissection

作　　者：吴智勇[1] 王志维[1] 毛志福[1] 夏军[1] 张遵严[1] 陈雪芬[1] 邓宏平[1] 徐鹏[1] 李罗成[1] 

机构地区：[1]武汉大学人民医院心血管外科,430060

出　　处：《中华外科杂志》2011年第3期236-239,共4页Chinese Journal of Surgery

摘　　要：目的总结改良主动脉全弓置换加支架象鼻术治疗DeBakeyI型主动脉夹层的临床经验。方法2006年1月至2010年10月，101例DeBakeyI型主动脉夹层患者接受改良全弓置换加支架象鼻术，其中急诊手术73例。全组男性76例，女性25例；年龄21～77岁，平均（49±8）岁。手术包括升主动脉置换术31例、Bentall术29例、Wheat术7例、David术34例。支架象鼻术的同时行左锁骨下动脉开窗以重建血运。在深低温停循环时改行双侧顺行脑灌注下完成脑保护。结果手术改良后平均心肺转流时间（212±40）min，平均心肌阻断时间（95±16）min，平均停循环时间（42±8）min。手术死亡I例，住院死亡5例，分别死于感染败血症、急性肾功能衰竭、偏瘫并发多器官功能衰竭。双侧脑灌注后脑血管意外和短暂脑神经功能障碍的发生率低于选择性脑灌注。76例患者出院前复查主动脉CT血管造影，人工血管无扭曲，血流通畅，胸降主动脉夹层假腔闭合率为78．9％。71例随访5～49个月，其中50例复查CT血管造影，胸降主动脉夹层假腔闭合率为88．0％，无晚期死亡及再次手术者。结论改良的全弓置换加支架象鼻术治疗DeBakeyI型主动脉夹层安全、有效，可减少术后并发症。Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey I thoracic aortic dissection. Methods From January 2006 to October 2010, 101 cases of DeBakey I aortic dissection were treated by modified total arch replacement and stent elephant trunk technique, in which emergency surgery for 73 cases. There were 76 male and 25 female patients, aged from 21 to 77 years with a mean of （49 -＋ 8） years. Intraoperative ascending aortic replacement in 31 cases, Bentall procedure in 29 cases, Wheat procedure in 7 cases, David procedure in 34 cases. At the same time stent elephant trunk in the left subclavian artery corresponding position was windowed to rebuild the blood supply. Deep hypothermic circulatory arrest cerebral protection was completed by bilateral antegrade cerebral perfusion. Results The mean cardiopulmonary bypass time was （212 ±40） rain, mean myocardial occlusion time was （95 ± 16） min, mean circulatory arrest time was （42± 8） rain. Operative mortality was 1 case and hospital mortality was 5 case, which died of septicemia, acute renal failure and hemiplegia complicated with multiple organ failure. Compared with selective cerebral perfusion, the incidence of postoperative cerebral vascular accident and transient neurological dysfunction decreased. Seventy-six cases received aorta CTA before discharged, the closure rate of descending thoracic aortic dissection false lumen was 78.9%. Seventy-one patients were followed up for 5 to 49 months, 50 cases was reviewed by CTA, of which closure rate of descending thoracic aortic dissection false lumen was 88.0%, no late death and re-surgery. Conclusions elephant trunk technique treatment for patients with effective, with less postoperative complications. The modified total aortic arch replacement and stent DeBakey I thoracic aortic dissection was safe and effective, with less postoperative complications.

关 键 词：主动脉瘤 胸 心肺转流术 人工血管 

分 类 号：R593.2[医药卫生—内科学]