Stanford A型胸主动脉夹层的外科治疗  

Surgical Treatment of Standford Type A Dissection of Thoracic Aorta

作　　者：杨绍军[1] 周云[1] 向利[1] 李旭[1] 王曦[1] 

机构地区：[1]昆明医学院第二附属医院胸心血管外科,云南昆明650101

出　　处：《昆明医学院学报》2012年第1期57-60,66,共5页Journal of Kunming Medical College

基　　金：云南省科技计划基金资助项目(2008CD026);云南省卫生科技计划基金资助项目(2009NS076)

摘　　要：目的总结Stanford A型胸主动脉夹层的外科治疗经验.方法 2001年1月至2010年2月手术治疗Stanford A型胸主动脉夹层患者42例(DeBakeyⅠ型27例、DeBakeyⅡ型15例).急性期33例(<14 d),慢性期9例(>14 d).手术常规采用中低温体外循环方法,股动脉或右锁骨下动脉插管.深低温停循环者常规实施脑保护措施,停循环期间选择性顺性脑灌注.手术方式:升主动脉替换术11例;Bentall术13例;David手术+部分主动脉弓替换术1例;部分主动脉弓替换3例;部分主动脉弓替换+术中降主动脉支架植入3例;全弓替换术5例;全弓替换术+术中降主动脉支架植入6例.择期手术25例;急诊手术17例.结果术后早期并发症率40.5%(17/42例),其中术后昏迷1例,低心排1例,恶性心律失常1例,出血4例,呼吸衰竭6例,肾功能衰竭2例,上消化道出血2例.死亡7例,围术期病死率16.7%(7/42例),其余患者均治愈出院.结论 Standford A型夹层发病急骤,常危及生命,宜迅速作出诊断和分型,尽快进行手术治疗,争取最佳治疗时机.结合术者的经验及病人的病情、病变部位,常规根据夹层破口的位置,设计个体化的手术方式,急诊手术尽量采用安全,简化的术式,可提高手术及抢救成功率;主动脉近端和远端吻合口处理成功与否是整个手术成功的关键;停循环期间选择性顺性脑灌注可有效减少中枢神经系统并发症.Objective To summarize the experience in surgical treatment of Standford type A dissection of thoracic aorta. Methods Between Jan 2001 and Feb 2010, 42 patients with type A dissection of thoracic aorta underwent surgical repair （DeBakey type I in 27cases and DeBakey type lI in 15 cases）. The 42 patients included 33 cases of acute dissection （ 〈 14 days） and 9 cases of chronic dissection （ 〉 14 days）. All patients were operated under cardiopulmonary bypass with femoral artery or right axillary artery cannulation. The strategies of brain protection were used in case of deep hypothermic circulatory arrest （DHCA） , during circulatory arrest, selective antegrade cerebral perfusion （SACP） was performed. Operative procedures： ascending aorta replacement was in 11, Bentall procedure was in 13, David procedure and hemiarch replacement was in 1, hemiarch replacement was in 3, hemiarch replacement and open stent grafting was in 3, total aortic arch replacement was in 5, total aortic arch replacement and open stent grafting was in 6. Selective operation was performed in 25 cases, and emergency operation was performed in 17 cases. Results Early postoperative complication rate was 40.5 % （17/42）, which included coma in 1 patients, low cardiac ouput in 1, arrhythmia in 1, bleeding in 4, respiratory failure in 6 , acute renal failure in 2, upper gastrointestinal beeding in 2. The mortality rate was 16.7% （7/42）during perioperative period, other patients were cured and discharged from hospital. Conclusions StaMford type A aortic dissection is a abrupt-onset and life-threatening medical emergency associated with high rates of morbidity and mortality, it requires timely and accurate diagnosis and surgical treatment. It can improve the success rate of surgical treatment by making a safe, simple and individualized surgery procedure that considering the skill of the surgical team, the location of rupture and the hemodynamic status of the patients, espically in emergerncy cases. The management skill of

关 键 词：胸主动脉夹层 外科治疗 体外循环 

分 类 号：R543.1[医药卫生—心血管疾病]