StanfordA型主动脉夹层手术中的主动脉根部处理  

Aortic root surgery in Stanford A aortic dissection operations

作　　者：李罗成[1] 王志维[1] 吴红兵[1] 胡小平[1] 柳亚奎[1] 王杰[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》2011年第6期331-333,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受湖北省自然科学基金资助（2008CHB421）

摘　　要：目的总结StanfordA型主动脉夹层手术中主动脉根部处理的临床经验。方法根据主动脉夹层累及主动脉根部的程度及主动脉根部基础病变，对59例StanfordA型主动脉夹层病人进行主动脉根部处理。Bentall手术31例，Wheat手术15例，David手术13例。结果手术死亡1例（1．72％）。术后一过性精神状态异常17例；术后感染2例，1例死亡；胸骨哆开1例；单侧下肢血供障碍1例，二期行股股分流术后恢复正常。出院前复查心脏彩超、主动脉CT血管成像及心电图，均正常。随访2—54个月。4例死于非心源性疾病，余者正常。结论根据主动脉夹层累及主动脉根部的程度及主动脉根部基础病变，制定相应处理方案，可显著提高手安全性并改善预后。Objective To summarize the experience of aortic root surgery in Stanford A aortic dissection operations. Methods From January 2005 to September 2010, the clinical data of 59 patients with Stanford A aortic dissection was analyzed. There were 43 men and 16 women , ranging in age from 21 to 74 years old, duration of disease varied from 16 hours to 27 days. Among the group, 31 complicated by aortic valve incompetence, 12 Marfan syndrome, 9 single lower limb blood supply dysfunction, 6 right coronary artery involvement. All cases received aortic root surgery under deep hypothermic circulatory arrest. Bentall procedure was performed in 31 patients, Wheat procedure in 15 patients and David procedure in 13 patients. Results The time of cardiopulmonary bypass in the group was 149 to 204 min with an average of （ 171 ± 19 ） rain, and the cross clamp time was 81 to 122 min with an average of （104 ± 13） min, and the arrest time was 30 to 47 min with an average of （39 ±7） min. There was 1 case of operative death, which was treated on an emergency basis. Postoperative complications occurred in 20 cases. 17 cases experienced temporary mental dysfunction, 2 cases were infected with MRSA, 1 of which died from MODS, 1 case of single lower limb blood supply dysfunction remained after the first operation and recovered by reoperation （bilateral femoral bypass operation） . All cases were reexamined before discharge, postoperative mean LVEF was （56.3 ± 3.4） % （ranged 51% -62% ）, aortic annular diameter varied from 22 mm to 27 mm, aortic sinus diameter range from 23 mm to 31 mm. 51 patients were followed up, with a mean follow-up time of （24.9 ± 17.2） months （ ranged 2-54 months）. 54 patients of Stanford A aortic dissection survived well with normal lives and activities. Four non cardiac deaths, one was chronic renal failure, the others were brain hemorrhage. Conclusion Prognosis and operative security of Stanford A aortic dissection patients can be significantly improved by individualized aortic roo

关 键 词：主动脉夹层 心脏外科手术 

分 类 号：R654.3[医药卫生—外科学]