术中支架象鼻技术治疗Stanford B型主动脉夹层  

Clinical application of intraoperative stented elephant trunk technique on Stanford type B dissection

作　　者：赵海鹏[1] 孙立忠[1] 朱俊明[1] 刘永民[1] 郑军[1] 马维国[1] 

机构地区：[1]北京市心肺血管疾病研究所首都医科大学附属北京安贞医院心脏外科北京市大血管中心,100029

出　　处：《中华胸心血管外科杂志》2012年第12期721-724,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结术中支架象鼻技术治疗StanfordB型主动脉夹层的临床效果和经验。方法2009年3月至2011年12月24例锚定区小足或左锁骨下动脉受累及合并升主动脉或心脏病变的Stanford B型主动脉夹层的患者在北京安贞医院接受手术。其中男20例，女4例，年龄（50．6±9．8）岁。合并高血压20例，主动脉瓣关闭不全2例，主动脉根部瘤1例，二尖瓣关闭不全1例，主动脉缩窄1例。14例有吸烟史。4例为胸降主动脉覆膜支架术后内漏。结果24例患者均行直视下支架象鼻术，同期左锁骨下动脉左颈总动脉转流5例，主动脉瓣替换＋升主动脉成形3例，左锁骨下动脉重建2例，二尖瓣和主动脉瓣置换1例，升主动脉降主动脉人工血管转流1例。体外循环（163．1±48．6）min，低流量选择性脑灌时间（29．1±12．4）min。无围手术期死亡。二次开胸止血1例；呼吸功能不全气管切开1例；无截瘫及卒中发生。无住院死亡，并发症发生率8．3％（2／24例）。1例失访；随访23例，随防率95．8％（23／24），平均随访24个月，随访期间2例因I型内漏行修补术，1例因支架远端假性动脉瘤行主动脉覆膜支架修复。20例（86．4％）患者支架附近可见血栓形成。结论对锚定区不足或左锁骨下动脉受累及合并升主动脉或心脏病变的StanfordB型主动脉夹层患者行直视下支架象鼻手术是一种有效的外科治疗手段，可以获得满意的临床效果。远期结果需进一步随访。Objective To summarize our clinical experience and results of intraoperative stented elephant trunk tech- nique on Stanford type B dissection. Methods From March 2009 to December 2011,24 patients of Stanford type B aortic dis- section with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk technique in Beijing AnZhen Hospital. Of these patients, 20 were male and 4 female, with a mean age of （50.6 ± 9.8 ） years, （36 -77 years）. Associated with hypertension in 20 cases, aortic root aneurysm in 1 case, aortic insufficiency in 2 cases, mi- tral insufficiency in 1 case, coarctation of the aorta in 1 case; 14 cases had a history of smoking. The postoperative internal fis- tula after descending thoracic aortic stent-graft occurred in 4 cases. Results 24 patients of Stanford type B aortic dissection with insufficient anchored zone or the left subclavian artery involvement underwent intraoperative stented elephant trunk tech- nique. Concomitant procedures included the bypass from the left subclavian artery to the left common carotid artery in 5 cases, aortic valve replacement and ascending aortic plasty in 3 cases, left subclavian artery reconstruction in 2 cases, double valve re- placement in I cases, the bypass from ascending aorta to descending aorta each in one. The times of eardiopulmonary bypass and selective cerebral peffusion averaged （ 163. 1± 48.6） min and （29.1 ±12.4） min, respectively. There was no in-hospital mortality. Complications occurred in 2 patients （2/24, 8.3% ）, including respiratory insufficiency and mediastinal bleeding requiring reoperation, each in one. No paraplegia or stroke occurred postoperatively. Follow-up was available in 23 patients （23/24, 95.8% ）. During the follow-up, type I endoleak occurred in 2 patient and needed surgical repair. One patient un- derwent endovascular aortic repair due to pseudoaneurysm of the distal end of the stent. The complete thrombosis ratio of the false lumen was 86.4%

关 键 词：主动脉夹层 支架象鼻术 左锁骨下动脉 锚定区 

分 类 号：R654.3[医药卫生—外科学]