主动脉全弓、右半弓替换治疗Stanford A型主动脉夹层的效果比较  

Operative strategy for Stanford type A aortic dissection： total arch versus henri-arch replacement

作　　者：刘圣辰[1] 黄福华[1] 秦卫[1] 陈鑫[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院南京市心血管病医院胸心外科,210006

出　　处：《中华胸心血管外科杂志》2014年第6期331-334,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金（81370259）

摘　　要：目的比较主动脉全弓替换与主动脉右半弓替换对StanfordA型主动脉夹层的疗效。方法2001年8月至2013年7月，208例StanfordA型主动脉夹层患者在南京医科大学附属南京医院接受手术治疗，其中主动脉全弓替换121例（A组），主动脉右半弓替换87例（B组）。回顾性分析两组患者的临床资料，比较两组患者的体外循环时间、主动脉阻断时间、选择性脑灌注时间、术后并发症、住院死亡比例及远期随访结果。结果两组患者的年龄、性别比以及术前合并症无统计学差异。A组与B组相比，体外循环时间[（247．68±58．65）min对（212．68±60．75）min，P=0．000]、主动脉阻断时间[（154．85±45．96）min对（137．83±38．91）min，P=0．000]、选择性脑灌注时间[（36．98±10．62）min对（29．85±13．46）min，P=0．000]长；术后并发症的发生率（14．0％对10．3％，P=0．619）和住院死亡比例（9．1％对8．0％，P=0．791）两组间差异无统计学意义。A组与B组比较，术后随访时间（21．86±18．89）个月对（61．23±38．57）个月（P=0．000），随访率94．5％对96．3％（P=0．585）。降主动脉假腔内血栓形成率A组（91．8％）高于B组（23．8％），差异有统计学意义，P=0．000。二次手术率（0对2．3％，P=0．095）和远期生存率（6．4％对6．3％，P=0．975）组间差异无统计学意义。结论手术是唯一可以挽救StanfordA型主动脉夹层患者生命的治疗方法，主动脉全弓替换与主动脉右半弓替换相比，虽然体外循环时间、主动脉阻断时间、选择性脑灌注时间稍长，但是住院死亡比例、术后并发症的发生率未增加，远期生存率相似。全弓替换的假腔内血栓形成率更高。Objective This report is to compare the difference outcome between total arch replacement and hemi-arch replacement for Stanford type A aortic dissection. Methods The subjects were 208 consecutive patients, including 121 who received total arch replacement（ group A） and 87 who had hemi-arch replacement（ group B） for Stanford type A aortic dissec- tion from August 2001 to July 2013 in Nanjing Hospital Affiliated to Nanjing Medical University. The eardiopulmonary bypass （CPB） time, average cross-clamping time, selective cerebral perfusion （SCP） time, complications, in-hospital mortality and follow-up after surgery were retrospectively compared between the A and B groups. Results The age, sex ratio, preoperative complications do not show a significant difference between the A and B groups. The CPB time [ （247.68± 58.65 ） min vs （ 212.68± 60.75 ） rain, P = 0. 000 ], cross-clamping time [ （ 154.85 ± 45.96 ） min vs （ 137.83 ± 38.91 ） min, P = 0. 000 ] and SCP time [ （ 36.98 ± 10.62 ） min vs （ 29.85 ± 13.46 ） min, P = 0. 000 ] of group A are all longer than group B. The incidence of postoperative complications（ 14.0% vs 10.3% , P =0. 619） and in-hospital mortality（9.1% vs 8.0% , P =0. 791 ） between the A and B groups do not have a significant difference. The mean time of follow-up differed significantly between two groups [ （ 21.86± 18.89 ） months vs （61.23± 38.57 ） months, P = 0. 000 ] and did not differ in the rate of follow-up （ 94.5 % vs 96.3 % , P =0. 585 ）. The rate of false lumen thrombosed at the proximal descending aorta showed a significant difference between the twogroups （ 91.8% vs 23.8 %, P = 0. 000） , but the rate of secondary surgical intervention （0 vs 2.3 % , P = 0. 095 ） and follow-up death （ 6.4% vs 6.3 %, P = 0. 975 ） do not. Conclusion For the Stanford type A aortic dissection patients, surgery is the only treatment that can save lives. Total arch replacement need more time in CPB, cross-clamping and SCP, but the complic

关 键 词：主动脉 动脉瘤 夹层 全弓替换 半弓替换 预后 随访 

分 类 号：R654.3[医药卫生—外科学]