主动脉全弓置换加术中支架“象鼻”手术治疗StanfordA型主动脉夹层  

Total arch replacement combined with stented elephant trunk implantation for Stanford type A aorticdissection

作　　者：刘志平[1] 朱宪明[1] 李淑珍[1] 张玉龙[1] 王坚[1] 郭俊晓[1] 高荣[1] 任杰[1] 赵龙[1] 王敏[1] 

机构地区：[1]内蒙古医学院附属医院胸心外科,呼和浩特010050

出　　处：《中国医师杂志》2011年第8期1060-1062,1066,共4页Journal of Chinese Physician

摘　　要：目的总结采用升主动脉及全弓替换加支架“象鼻”手术治疗StanfordA型主动脉夹层的临床经验。方法对本院连续收治的36例StanfordA型主动脉夹层患者行升主动脉及全弓替换加支架“象鼻”手术，其中男30例、女6例，年龄29～65（52．3＋6．35）岁。均为急性主动脉夹层。均在深低温停循环、低流量选择性脑灌注下手术。单纯行升主动脉及全弓替换加支架“象鼻”手术19例[同期行冠状动脉旁路移植术（CABG）2例]；主动脉根部替换手术（Bentall术）＋全弓替换＋支架“象鼻”手术8例，主动脉瓣成形术＋全弓替换＋支架“象鼻”手术9例（同时行主动脉左冠窦重建4例）。结果全组体外循环时间（160＋31）min，主动脉阻断时间（101＋26）min，选择性脑灌注（下半身停循环）时间（31±16）min。住院死亡2例（5．5％，2／36），1例术后9d死于多脏器功能衰竭，另1例术后9d死于脑梗死。手术并发症：血管吻合El出血二次开胸止血1例；低氧血症8例，需气管切开呼吸机辅助2例；术后一过性脑功能紊乱6例，以谵妄、兴奋为主，持续48—72h后恢复；声音嘶哑1例；乳糜胸6例，治疗后痊愈。34例存活患者出院前行cT检查：升主动脉及弓部人工血管血流通畅，支架“象鼻”段降主动脉假腔完全消失，主动脉管壁结构恢复。在支架“象鼻”远端，降主动脉真腔较术前明显扩大，假腔缩小。随访2～36个月，无晚期死亡及需要再次手术者。结论升主动脉及全弓替换加支架“象鼻”手术是治疗急性StanfordA型主动脉夹层安全、有效的方法。Objective To improve the long term outcomes of the surgery for Stanford type A aortic- dissection, we performed ascending aorta and total aortic arch replacement combined with transaorticstented graft implantation into the descending aorta for acute type A aortic dissection. Methods From May 2005 to February 2011, 36 consecutive patients with acute Stanford type A aorticdissection underwent this proce- dure. Right axillary artery cannulation was routinely used forcardiopulmonary bypass and selected cerebral perfusion. The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest. The stented elephant trunk was a 10 cm long selfexpandable graft. 34 patients were followed up for 2 ~ 36 months. Results Cardiopulmonary bypass time was （160 -＋ 31 ）rain, average cross clamp time was （101 ＋26）rain, and average selective cerebral perfusion and lower body arrest time was （31 ~ 16 ）min. The in-hospital mortality was 5.5% （2/36）. One patient died of muhi-organ failure postoperatively and an- other died of cerebral infarction 9 day after surgery. No one suffered from spinal cord injury perioperatively. There was no late death during follow up. Conclusions Ascendingaorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective way in closing the residual false lumen of the descending aorta and might contribute to better long term outcomes of type A aortic dissection.

关 键 词：主动脉 胸/外科学 支架 动脉瘤 夹层/外科学 主动脉疾病/外科学 心脏外科手术 

分 类 号：R654.3[医药卫生—外科学]