杂交全主动脉弓修复术治疗急性A型主动脉夹层弓部受累的围术期和中期随访结果  

Perioperative and mid-term outcomes of hybrid total arch replacement for acute type A aortic dissection

作　　者：李岩[1] 常谦[1] 于存涛[1] 钱向阳[1] 孙晓刚[1] 

机构地区：[1]中国医学科学院阜外心血管病医院心血管外科

出　　处：《临床外科杂志》2015年第9期674-676,共3页Journal of Clinical Surgery

摘　　要：目的总结杂交全主动脉弓修复术治疗急性A型主动脉夹层弓部受累的临床经验。方法累及主动脉弓的急性A型主动脉夹层患者50例，在杂交手术室完成一期杂交全主动脉弓修复术。分别采用正中开胸、低温体外循环下行升主动脉替换和（或）主动脉瓣置换和（或）冠脉旁路移植术，顺行或逆行主动脉弓部腔内覆膜支架隔绝术。比较体外循环组与同期采用传统深低温停循环手术行主动脉弓置患者的围术期结果和随访结果。结果全组均成功同期完成手术并置入覆膜支架。体外循环（130．7±22．6）分钟，主动脉阻断（48．6±12．8）分钟；支架直径（33．8±0．6）mm，支架长度（187．9±6．3）mm；1例术后12d死于严重腹腔缺血，1例术后30d死于肺部严重感染，1例术后32d死于严重凝血功能障碍。杂交全主动脉弓修复术体外循环和主动脉阻断时间明显少于传统手术组（P〈0．05）；杂交手术者ICU时间明显少于传统手术组（P〈0．05）；杂交手术组患者术后脑卒中和肺部感染发生率也明显少于传统手术组（P〈0．05）。47例患者存活出院接受随访，随访时间12～48个月，平均（28．4±10．9）个月，3例患者随访死亡，随访死亡率与传统手术组比较无明显差异。结论杂交全主动脉弓修复术治疗急性A型主动脉夹层弓部受累安全、有效，与传统手术比较，手术时间和CUI住院时间短，手术创伤小，旧术期神经系统和呼吸系统并发症发生率低，随访结果亦不劣于传统手术组。Objective To summarize clinical experiences of hybrid total arch replacement for a- cute type A aortic dissection. Methods Fifty patients with acute type A aortic dissection received hybrid total arch replacement. Aorta replacement, aortic valve replacement, coronary artery bypass grafting, and endovascular graft exclusion were performed under hypothermia extracorporeal circulation via median ster- notomy. At the same time, patients with conventional aortic arch replacement under deep hypothermic cir- culatory arrest were enrolled as controls. Perioperative and mid-term tbllow-up outcomes were compared between groups. Results All surgeries were successfully completed with the placement of covered stents. The extraeorporeal circulation time was （ 130.7±22.6 ） min, the duration of aortic cross clamping was （48.6 ± 12.8 ）mm, the stent diameter was （33.8±0.6 ）mm, and the stent length was （ 187.9 ± 6.3 ）mm. One patient died of severe abdominal isehemia on the 12th day ＇after operation. One patient died of severe pulmonary infection on the 30th day after operation. One patient died of severe coagulation disorders on the 32th day ＇after operation. In the hybrid group, the extracorporeal circulation time, duration of aortic cross clamping, ICU stay,and postoperative stroke and pulmonary infection were lesser（ P 〈 0.05 ）. Tbe rest 47 patients were followed up for 12- 48 months, with an average of（ 28.4± 10.9 ! months. Three patients died and there was no significant difference in mortality between groups. Conclusion For acute type A aortic dissection, hybrid total arch replacement is a safe and effective strategy with less operation time and hospital stay. It has less trauma, fewer complieations, and similar follow-up outcomes compare with the conventional surgery.

关 键 词：主动脉夹层 杂交 预后 

分 类 号：R654.3[医药卫生—外科学]