一站式杂交手术治疗急性Stanford A型主动脉夹层  

One-stop hybrid operation for acute type A aortic dissection

作　　者：尚玉强[1] 戴仕林[1] 吴伟[1] 易凡[1] 李炳[1] 王贤灿[1] 程龙[1] 

机构地区：[1]武汉市中心医院心脏大血管外科,武汉430014

出　　处：《临床心血管病杂志》2016年第8期823-825,共3页Journal of Clinical Cardiology

摘　　要：目的：总结一站式杂交手术治疗Stanford A型主动脉夹层的手术方法及早期治疗效果。方法：对15例急性Standford A型主动脉夹层患者采用一站式杂交手术,即升主动脉及弓上分支血管人工血管置换联合主动脉腔内修复手术,观察其手术时间、术后麻醉清醒时间、出血量、呼吸机辅助时间等指标。结果：15例患者均顺利完成手术,1例患者术后死于肺部感染。全组病例中体外循环时间为82~136min,主动脉阻断时间为30~65min。术后在监护病房中,有12例患者在6h内清醒。11例患者在术后48h之间拔出气管插管。术后首个24h引流量在325~575ml。术后两周和3个月左右复查主动脉CTA提示,人工血管形态良好,分支血管血流通畅,支架血管无移位。夹层近端破口封闭良好,无造影剂渗漏,支架附近假腔完全血栓化。结论：一站式杂交手术治疗Stanford A型主动脉夹层,避免深低温停循环,缩短手术时间,减少手术创伤,降低了手术后并发症的发生率,在近期能表现出很好的治疗效果。但由于其覆膜支架材料的限制,其远期效果尚不明确,还需要进一步随访总结。Objective：To summarize the surgical methods and early treatment results of A type Stanford aortic dissection with one-stop hybrid operation.Method：From December 2014 to March 2016,we performed one-stop hybrid operation in 15 patients with acute aortic dissection.We observed the index of the operative time,the awake time,the bleeding volume,and the ventilator assisted time.Result：The 15 patients were successfully operated,and 1cases died of pulmonary infection after operation.The duration of cardiopulmonary bypass was 82-136 min and aortic clamp was 30-65 min.The 12 patients were wide awake within 6hours after operate.Tracheal intubation was pulled out in 11 patients within 48 hours.During the first 24 hours,the volume of drain was between325-575 ml.Two weeks and three months after the operation,the aorta CTA of the patients showed good.Conclusion：One-stop hybrid operation in the treatment of type A aortic dissection,without deep hypothermic circulatory arrest,can shorten the operation time,and reduce the surgical trauma,and the complications after surgery.However,due to the limitations of its coated stent materials,its long-term effect is not clear,but also need to be further followed up.

关 键 词：A型主动脉夹层 一站式杂交手术 急性 

分 类 号：R544.1[医药卫生—心血管疾病]