主动脉弓置换加“象鼻”支架手术治疗StanfordA型主动脉夹层  

Total arch replacement combined with stented elephant trunk implantation for Stanford A aortic dissection

作　　者：杨建安[1] 李刚[1] 王湘[1] 于洪涛[1] 王小雷[1] 叶小青[1] 黄小蝶[1] 陈伟新[1] 刘希伶[1] 

机构地区：[1]深圳市孙逸仙心血管医院外科,广东省518020

出　　处：《中国心血管病研究》2012年第2期145-148,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨采用升主动脉及全弓置换加“象鼻”支架手术治疗StanfordA型主动脉夹层的临床意义。方法2010年5月至2011年10月，应用升主动脉及全弓置换加“象鼻”支架手术治疗StanfordA型主动脉夹层患者16例，男性12例，女性4例，平均年龄47（30-67）岁；其中急性主动脉夹层12例、慢性夹层4例，均在深低温停循环、低流量选择性脑灌注下手术。结果急诊手术12例，择期手术4例。行主动脉弓置换及“象鼻”支架术2例，升主动脉及全主动脉弓置换1例，升主动脉及全主动脉弓置换加“象鼻”支架手术13例，其中同期行Bentall术2例、主动脉根部成形术8例。心肌阻断时间59-137（104-31）min，选择性脑灌注时间17-57（29-11）min。术后肾功能衰竭2例，1例经血液透析治疗后肾功能恢复，另1例因多器官功能衰竭死亡。15例患者出院，随访1个月至1．5年，1例患者于术后约1个月双下肢肌肉坏死，在外院施行了截肢手术，8例患者不同程度恢复工作，无晚期死亡或再次手术病例。结论升主动脉及全弓置换加“象鼻”支架手术是治疗StanfordA型主动脉夹层安全、有效的方法。Objective To summarize the clinical experience of the surgery for Stanford type A aortic dissection, we performed ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for type A aortic dissection. Methods From May 2010 to September 2011, 16 consecutive patients with acute or chronic aortic Stanford type A dissection underwent this procedure. Right axillary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion. The stented elephant trunk was implanted through the aortic arch under deep hypothermic circulatory arrest. Results Twelve cases were undergone emergency operation. Average selective cerebral perfusion and lower body arrest time was （29-11）min. Two patients suffered from acute kidney failure. One patient died of multi-organ failure postoperatively. 15 patients discharged, follow-up 1 month to 1.5 years, 1 patient suffered from bilateral lower limb muscle necrosis about a month after operation, and was obliged to do the amputation, eight patients to return to work in different degree and There was no late death during follow up. Conclusion Ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta might contribute to the better long term outcomes of type A aortic dissection.

关 键 词：主动脉疾病 血管假体置入 支架 

分 类 号：R654.2[医药卫生—外科学]