个体化组合式分支覆膜支架重建主动脉弓治疗Stanford A型主动脉夹层  

Clinical analysis of total aortic arch reconstruction with a novel individualized combined branched stent grafting technique for patients with Stanford A aortic dissection

作　　者：申运华[1] 严中亚[1] 严光[2] 卢中[1] 程光存[1] 王晓玲 朱正艳[1] 雷虹[1] 吴一军[1] 

机构地区：[1]安徽医科大学附属省立医院心脏外科,合肥230001 [2]安徽医科大学附属省立医院老年病科,合肥230001 [3]安徽医科大学附属省立医院保健办公室,合肥230001

出　　处：《中华外科杂志》2014年第6期436-441,共6页Chinese Journal of Surgery

基　　金：安徽省科技攻关计划资助项目（13010142198）

摘　　要：目的 探讨个体化组合式分支覆膜支架重建主动脉弓部手术治疗Stanford A型主动脉夹层的疗效,并与传统的全弓置换加支架“象鼻”手术进行比较.方法 回顾性分析2007年1月至2013年7月接受手术治疗的Stanford A型主动脉夹层患者的临床资料,筛选出接受全弓置换加支架“象鼻”手术及个体化组合式分支覆膜支架重建主动脉弓的患者共44例,男性29例,女性15例,年龄25～59岁,平均年龄（42±9）岁.其中行全弓置换＋象鼻支架置入术22例（全弓置换组）;行个体化组合式分支覆膜支架重建主动脉弓部手术22例（个体化组）.两组患者的年龄、性别和病情差异无统计学意义（P＞0.05）.术前均行超声心动图、主动脉CT血管造影检查.术后1个月进行临床随访和超声心动图、主动脉CT血管造影复查.结果 患者手术全部成功,无死亡病例.全弓置换组的心肺转流时间、心肌阻断时间、停循环或选择性脑灌注时间、术后胸腔引流量、术后呼吸机辅助呼吸时间、输血量均高于个体化组（f=2.791～43.465,均P＜0.05）.术后1个月,全弓置换组和个体化组胸主动脉最大内径均小于术前[（33 ±1）mm比（45 ±6） mm（t=10.076,P=0.000）,（33 ±2）mm比（45 ±8）mm（t =5.979,P=0.000）];两组射血分数与术前比较差异无统计学意义（P＞0.05）.结论 个体化组合式分支覆膜支架重建主动脉弓部手术和全弓置换加支架“象鼻”手术治疗Stanford A型主动脉夹层均有良好的近期临床疗效,前者简化了手术步骤,缩短了手术时间,减少了输血量、术后胸腔引流量.Objective To compare the clinical efficacy between total aortic arch reconstruction with a individualized combined branched stent grafting technique and total aortic arch replacement combined with stented elephant trunk implantation for patients with Stanford A aortic dissection.Methods Totally 44 patients with Stanford A aortic dissection treated with surgical treatment from January 2007 to July 2013 were included in this study.The patients were divided into two groups.Group A（n =22）patients were treated by total arch replacement with stented elephant trunk procedure.Group B （n =22） patients received individualized combined branched stent grafting technique.Age,gender and disease severity were similar between the two groups （all P ＞ 0.05）.Echocardiography and aortic CT angiography were performed preoperation and at 1 month after operation.Results Operation was successful in all 44 patients.Cardiopulmonary bypass time,aortic cross clamp time,circulation arrest time and duration of ventilator assisted breathing were significantly longer,postoperative drainage volume and blood transfusion volume were significantly larger and hospitalization cost was significantly higher in group A patients compared those in group B patients （t =2.791 to 43.465,all P ＜0.05）.One month after operation,the maximum internal diameter of aorta was smaller than pre-operation in both group A （（33 ± 1） mm vs.（45 ± 6） mm,t =10.076,P=0.000） and group B （（33 ±2） mm vs.（45 ±8） mm,t =5.979,P =0.000）.Left ventricular ejection fraction had no significant difference before and 1 month after operation in both groups （P ＞ 0.05）.Conclusion The total aortic arch reconstruction with individualized combined branched stent grafting technique is technically easier,shortens the operation time,reduces the blood transfusion volume compared to the classical aortic arch operation.

关 键 词：动脉瘤 夹层 主动脉疾病 支架 治疗结果 

分 类 号：R654.3[医药卫生—外科学]