孙氏手术治疗急性Stanford A型主动脉夹层  

Sun＇s procedure for patients with acute type A aortic dissection

作　　者：潘俊[1] 宣煜龙[1] 陈小芳[1] 王强[1] 周庆[1] 范阜东[1] 王东进[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,210008

出　　处：《中华胸心血管外科杂志》2015年第6期325-327,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：南京市科技发展项目（201402026）

摘　　要：目的 探讨孙氏手术治疗急性Stanford A型主动脉夹层疗效,总结手术经验.方法 回顾性分析连续61例行孙氏手术治疗的急性Stanford A型主动脉夹层患者的临床资料,男53例,女8例;年龄（54±12）岁.统计分析患者手术、术后及随访资料.结果 全组体外循环（229±46） min,主动脉阻断（147±37） min,单侧选择性脑灌（35 ±9） min.术后二次开胸止血5例（8.2％）,急性肾功能衰竭3例（4.9％）,因肺部感染行气管切开3例（4.9％）,脊髓损伤2例（3.3％）,胸部切口愈合不良和右下肢骨筋膜室综合征各1例（1.6％）.术后30天内死亡5例,死因为低心排血量综合征2例,多器官衰竭、肺部感染和腹主动脉夹层破裂各1例.余患者痊愈出院.患者均随访,术后随访（5.1±0.7）年,术后1年生存率91.8％,5年生存率83.6％.结论 孙氏手术治疗急性Stanford A型主动脉夹层效果确切,术后中、远期生存率高,二次手术率低.Objective To analyze the early outcomes of the Sun＇ s procedure,which is an approach integrating total arch replacement using a 4-branched graft with implantation of a special stented graft in the descending aorta,and observe the mortality,morbidity and mid-term clinical results of postoperative in patients with acute type A aortic dissection （AAAD）.Methods Clinical data of 61 consecutive AAAD patients undergoing the Sun＇ s procedure were analyzed.There were 53 male and 8 female,aged （54 ± 12） years.61 patients had postoperative follow-up and the clinical effect of Sun＇ s procedure were retrospectively analyzed.Results Cardiopulmonary bypass time was （229 ± 46） min,aortic clamping time was （147 ± 37） min and unilateral selective cerebral perfusion time was （35 ± 9） min.Reoperation for excessive bleeding in 5 cases （8.2%）,acute renal failure in 3（4.9%）,tracheotomy patients for pulmonary infection in 3（4.9%）,and spinal cord injury in 2 （3.3%）,delayed thoracic incision healing in 1 （1.6%）,and osteofascial compartment syndrome of the right lower limb in 1 （1.6%）.The 30 day mortality is 8.2%,and the leading causes was low cardiac output syndrome in 2（3.3%）,multi-organ failure in 1 （1.6%）,pulmonary infection in 1 （1.6%） and ruptured of abdominal aortic dissection in 1 （1.6%）.The average follow-up time is（5.1 ± 0.7） years.Postoperative 1 year survival rate was 91.8%,5 year survival rate was 83.6%.Conclusion The Sun＇ s procedure has generated a relatively lower mortality rate in 61 patients with AAAD.Postoperative survival rate is high,and the reoperation rate is low.

关 键 词：主动脉 动脉瘤 夹层 心脏外科手术 随访 孙氏手术 

分 类 号：R692.5[医药卫生—泌尿科学]