分站式杂交手术治疗老年Stanford A型主动脉夹层  

Staged hybrid procedure for Stanford type A acute aortic dissection in the elderly

作　　者：于长江[1] 范瑞新[1] 罗建方 马少鸿[1] 范小平[1] 黄文晖[1] 刘媛[1] 庄建[1] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院,广州510080

出　　处：《岭南心血管病杂志》2012年第6期598-600,共3页South China Journal of Cardiovascular Diseases

基　　金：广东省科技计划项目:主动脉夹层相关危险因素的筛查与腔内治疗技术规范研究(项目编号:2009B030801267)

摘　　要：目的总结分站式一期杂交手术治疗老年Stanford A型急性主动脉夹层的临床经验及教训,探讨其可行性及适应证。方法2010年4月至2012年1月,广东省人民医院共8例老年(60岁以上)Stanford A型急性主动脉夹层患者接受分站式一期杂交手术治疗。8例患者均正中开胸,在中低温体外循环下以四分支人工血管行"升主动脉置换加主动脉弓去分支技术"。外科手术完成后送介入手术室逆行置入主动脉腔内覆膜支架。观察住院期间康复指标,定期复查全主动脉计算机断层扫描。观察人工血管通畅情况和夹层真假腔情况。结果本组患者无围术期死亡。体外循环时间(70.8±13.2)min;主动脉阻断时间(37.8±6.5)min。患者术后呼吸机使用时间为2～16 h,中位时间5 h,住重症监护病房时间2～20 d,中位时间2 d。所有患者全部接受随访,随访时间3～27个月,中位时间13个月,所有患者均生存。术后3个月复查全主动脉增强计算机断层扫描,结果满意。结论分站式一期杂交手术处理老年Stanford A型急性主动脉夹层安全、有效,能明显缩短手术时间、术后呼吸机辅助时间和住院时间,减轻患者的创伤和痛苦,避免深低温停循环的风险,取得满意的近期效果。Objectives To investigate the technical feasibility, clinical effects and operation indications of staged hybrid procedure for Stanford type A acute aortic dissection in the elderly. Methods From April 2010 to January 2012, 8 elder patients （over 60 years old） with Stanford type A acute aortic dissection received staged hybrid procedures in Guangdong General Hospital. All the patients received ＂ascending aortic replacement and aortic arch debranching＂ via sternal incision by moderate hypothermic circulatory arrest in the operation room firstly. After that, all were sent to the intervention room to finish endovascular management. Rehabilitation indexes, artificial blood vessels flow, real and false cavity of aortic dissection were observed. Results of computerized tomography scans were rechecked regularly. Results All the 8 patients were successfully operated. There was no perioperative death. Duration of cardiopulmonary bypass was （70.8±13.2） rain; duration of aortic cross-clamping was （37.8±6.5） min; duration of ventilated respiratory was 2-16 h, median duration was 5 h ; duration of intensive care unit stay was 2-20 d, median duration was 2 d. All the patients were followed up for 3-27 months, median duration was 13 months. All the patients survived. Disappearing of aortic dissection and thrombosis of the false lumen were demonstrated by intensive computerized tomographic angiography three months after operation. Conclusions Staged hybrid procedure is a safe and effective treatment for Stanford type A acute aortic dissection in the elderly, which can achieve satisfying short term outcomes by shortening durations of operation, ventilated respiratory and intensive care unit stay, as well as by reducing the pain of the patients and avoiding the risk of deep hypothermic circulatory arrest.

关 键 词：主动脉夹层 老年 杂交手术 主动脉腔内隔绝术 深低温停循环 

分 类 号：R543.1[医药卫生—心血管疾病]