Stanford A型主动脉夹层的外科治疗  

Surgical treatment of aortic dissection for type A

作　　者：陈梦苒[1] 韩继彪[1] 邬松[1] 张俊峰[1] 韩浩[1] 张桂敏[2] 

机构地区：[1]解放军105医院心血管外科,安徽省合肥市230001 [2]昆明医科大学第一附属医院(云大医院)心血管外科

出　　处：《中国心血管病研究》2014年第7期613-615,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结A型主动脉夹层外科治疗经验,探讨治疗A型主动脉夹层安全有效的术式和方法.方法 我院2008年1月至2013年11月对40例A型主动脉夹层患者予以外科治疗.Bentall（带瓣人造血管替代升主动脉根部和主动脉瓣膜,并移植左右冠状动脉）手术17例,其中10例同期行主动脉弓部替换＋降主动脉象鼻支架置入术;单纯升主动脉人工血管置换术8例;窦部成形＋主动脉瓣交界悬吊术6例,窦部替换＋主动脉瓣成形＋升主动脉半弓替换5例;升主动脉人工血管置换术＋主动脉全弓替换4例.采用深低温停循环技术（DHCA）12例,其余为浅中低温体外循环.采用冷血心脏停搏液灌注12例,组氨酸-色氨酸-酮戊二酸（HTK）停搏液灌注7例,冷晶体心脏停搏液21例.采用改良超滤技术19例.结果 手术死亡1例,围术期死亡4例,死亡率12.5％（5/40）,余均痊愈出院.结论 细化A型主动脉夹层的分型有利于制订个体化手术方案.术中止血彻底及心肌、脑保护确切可提高手术成功率.Objective To summarize the experience of surgical treatment of aortic dissection of type A,investigate a safe and effective procedure and plan to treat this kind of disease.Methods Forty patients with aortic dissection of type A accepted surgical treatment from January 2008 to November 2013.Seventeen patients underwent the Bentall procedure,including ten patients for a graft replacement of total aortic arch combined with the elephant trunk techniques in the same period.Simple graft replacement of ascending aorta in 8 cases.Aortic sinus plasty combined with suspension surgery for aortic valve at the junction in 6 cases.Aortic sinus replacement and aortic valvuloplasty combined with partial aortic arch replacement in 5 cases.A graft replacement of ascending aorta combined with total aortic arch replacement in 4 cases.Twelve cases with deep hyperthomic circulation arrest,other cases with the assistance of extracorporeal circulation.Cold blood cardioplegia perfusion in 12 cases.HTK cardioplegia perfusion in 7 cases.Cold crystalloid cardioplegia perfusion in 21 cases.Modified ultrafiltration technique in 19 cases.Results There were 1 death within operation,4 deaths postoperation.The overall mortality was 12.5％（5/40）,others were fully recoverd and discharged.Conclusion The subtype of aortic dissection of type A is much useful in determining specific surgical strategy.Complete hemostasis and exactly protection for cardiac and cerebral can enhance the successful rate in operation.

关 键 词：主动脉夹层 分型 外科治疗 

分 类 号：R654.2[医药卫生—外科学]