60岁以上老年Stanford A型主动脉夹层手术31例体会  

Experience in 31 cases of surgical treatment of Stanford type A aortic dissection aged 60 years or older

作　　者：王杰[1] 王志维[1] 夏军[1] 吴红兵[1] 吴智勇[1] 任伟[1] 周桢[1] 柳亚奎[1] 

机构地区：[1]武汉大学人民医院心血管外科,430060

出　　处：《临床外科杂志》2012年第2期123-125,共3页Journal of Clinical Surgery

基　　金：湖北省自然科学基金（2008CHB421）

摘　　要：目的 总结老年Stanford A型主动脉夹层外科治疗经验.方法 31例60岁以上老年A型主动脉夹层患者,均在深低温停循环、低流量脑灌注下手术.改良Wheat ＋全弓置换＋支架象鼻术1例,Wheat手术2例,David术＋全弓置换＋支架象鼻术3例,Bentall＋全弓置换＋支架象鼻术9例,其中1例同期行心包剥脱术,升主动脉＋全弓置换＋支架象鼻术16例,其中合并冠状动脉旁路移植术4例.结果 体外循环时间（221±43）min,主动脉阻断时间（132±41）min,停循环时间（47±12）min.术后发生一过性脑功能紊乱4例,经积极处理后均痊愈出院;肾功能衰竭3例,1例经床边血液透析治疗好转,2例放弃治疗;切口愈合不良2例;术后近期死亡2例,其中1例系院外夹层破裂急诊入院手术,死于失血性休克,1例死于多脏器功能衰竭;二次开胸止血1例.术后复查CT显示,升主动脉及弓部人工血管血流通畅,支架位置良好,无内漏.随访2～35个月,术后近期1例因抗凝意外死亡,无再次手术者.结论 对老年A型主动脉夹层患者,手术治疗安全、有效.术中根据病情采取恰当的外科处理,围术期及时发现并处理各种并发症,可以获得良好治疗效果.Objective To review the surgical treatment experience of type A aortic dissection （AD） in elderly patients. Methods Thirty -one patients with Stanford A AD underwent surgery under deep hypothermic circulatory arrest and selective cerebral perfusion, including modified wheat ＋ total arch ＋ stented elephant trunk（SET） implantation technique in 1 case, Wheat operation in 2, David ＋ total arch ＋ SET implantation technique in 3, Bentall ＋ total arch ＋ SET implantation technique in 9 among which concomitant pericardiectomy was performed on 1, and ascending aorta ＋ total arch ＋ SET implantation technique in 16 among which concomitant coronary artery bypass grafting was performed on 4. Results The average extracorporeal circulation time was （221 ± 43 ）min, the aortic cross -clamp time was （132 ± 41 ）min, and the circulatory arrest time was（47 ± 12）min. The complications included transient neurologic deficit in 4 cases,which were cured after active treatment; Renal failure in 3,in which 1 got improved after hemodialysis treatment and 2 gave up treatment; Poor wound healing in 2; Postoperative death in 2, in which 1 died of Hemorrhagic shock and 1 died of multiple organ failure ; Anastomostic hemorrhage in 1, which was treated by reoperation. Aortic CTA re - examination before discharge showed that the ascending aorta and arch were unobstructed, the site of SET was normal, and there was no leakage. Descending thoracic aortic true lumen expanded significantly compared with that before, the false lumen in not closed of the descending aorta thar appear thrombosis. Conclusion For Stanford type A AD in elderly patients, surgical management is safe and effective. Individualized surgical treatment, active maintenance of important organ function, and timely detection and management of various perioperative complications can obtain good therapeutic effect.

关 键 词：老年 主动脉夹层 心血管外科手术 

分 类 号：R654.3[医药卫生—外科学]