78例累及主动脉弓的主动脉疾病患者弓部处理方式及早期随访结果  

Treatment of 78 patients with aortic disease:Early follow-up results

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

机构地区：[1]华中科技大学同济医学院附属武汉中心医院心脏大血管外科,武汉430014

出　　处：《临床心血管病杂志》2017年第7期678-682,共5页Journal of Clinical Cardiology

基　　金：武汉市卫计委重点课题资助(No:WX16A03)

摘　　要：目的:总结累及主动脉弓的主动脉疾病的手术方法及早期治疗效果。方法:对78例累及主动脉弓的主动脉疾病患者采用多种手术方式,观察其围手术期病死率、严重并发症发生率等指标,并随访6个月,观察其内漏发生概率和假腔内血栓化程度等指标。结果:全组患者围手术期共有7例死亡,均为急性Stanford A型主动脉夹层,其中6例是全弓置换手术。18例患者术后出现各种类型神经系统并发症。35例患者术后出现肌酐水平升高,9例患者术后出现少尿或者无尿,需要进行床边血液透析滤过。22例患者术后出现急性呼吸窘迫综合征(ARDS)。6例患者术后出现应激性溃疡并消化道出血。术后6个月复查时,主动脉夹层植入支架的56例患者,除2例术后出现内漏以外,其余患者支架段主动脉假腔内均形成血栓,其中48例整个胸降主动脉均血栓化。全部存活的主动脉夹层患者中,有49例夹层累及腹主动脉及其远端,6个月复查时仅有9例患者远端血管假腔完全血栓化并趋向闭合,其余40例均存在远端真假腔共存的情况。结论:针对主动脉弓部病变的患者,目前有多种手术方式可供选择,而每种手术方式各有优势与不足。临床上应该根据患者的病变类型、身体状况和经济条件等综合考虑,选择合适的治疗方案。Objective：To summarize the surgical methods for aortic arch disease and the early treatment outcomes.Method：A variety of surgical procedures were performed in 78 patients with aortic arch disease.Perioperative mortality and other serious complications were observed and the followed up lasted for 6months,the probability of internal leakage and degree of thrombus were also investigated.Result：A total of 7patients died during the perioperative period.All of them had acute Stanford type A aortic dissection,6cases of whom underwent total arch replacement.18 patients suffered various types of neurological complications after the operation.35 cases of patients had postoperative elevated creatinine levels,9patients had postoperative oliguria or anuria,and needed hemodiafiltration.22 patients had postoperative acute respiratory distress syndrome（ARDS）.6patients had postoperative stress ulcer and gastrointestinal bleeding.6 months after surgery,56 cases with aortic dissection and stent implantation had thrombosis in aortic dissection false lumen,with the exception of 2patients had postoperative stent leakage,48 cases of whom were thrombosis in descending thoracic aorta.In all survivors with aortic dissection,the abdominal aortic dissection and distal end were involved in dissection in 49 cases.After 6months,9cases had distal false lumen thrombosis and tended to be closed,the remaining 40 cases had the distal false lumen coexist.Conclusion：For the patients with aortic arch lesions,there are a variety of surgical options,but each kind of surgical method has its own advantages and disadvantages.Clinical strategies should be based on the type of lesion patients,body shape and economic conditions and so on,to select the appropriate treatment plan.

关 键 词：主动脉弓 杂交手术 主动脉夹层 

分 类 号：R654.3[医药卫生—外科学]