内覆式主动脉弓部置换术在Stanford A型主动脉夹层手术中的应用  

Surgical experience and clinical results of intra-aortic arch technique in Stanford A aortic dissection operations

作　　者：朴虎林[1] 王勇[1] 郑晓梅[1] 朱翠琳 王维铁 黄茂勋[1] 魏士博 谢楚龙[1] 高星昊 徐健 柳克祥[1] Piao Hulin;Wang Yong;Zheng Xiaomei;Zhu Cuilin;Wang Weitie;Huang Maoxun;Wei Shibo;Xie Chulong;Gao Xinghao;Xu Jian;Liu Kexiang(Department of Cardiovascular Surgery, the Second Hospital of Jilin University, Jilin University, Changchun, 130041, China)

机构地区：[1]吉林大学第二医院心血管外科,长春130041

出　　处：《中华血管外科杂志》2018年第1期22-26,共5页Chinese Journal of Vascular Surgery

基　　金：吉林省医疗卫生服务能力建设项目（2017-154）;吉林省人才开发资金资助专项基金（2016-1110）

摘　　要：目的 总结内覆式主动脉弓部置换术在Stanford A型主动脉夹层治疗中的效果.方法2014年1月至2017年12月,对222例Stanford A型主动脉夹层患者行升主动脉置换＋内覆式主动脉弓部置换＋支架象鼻术.患者出院前行CT血管造影评估手术效果.结果222例患者在院死亡12例（5.4％）,截瘫3例（1.4％）,脑卒中9例（4.1％）.平均体外循环时间（135.2±29.1）min,停循环时间（37.5±7.1）min.出院时弓部假腔闭合率为81.8％,降主动脉假腔闭合率为69.4％.结论内覆式主动脉弓部置换术治疗Stanford A型主动脉夹层是一种简便、安全、有效的手术方法,短期随访结果良好.Objectives To summarize the surgical results of type A aortic dissection （TAAD） patients using the aortic arch inclusion technique. Methods From January 2014 to December 2017, 222 patients with TAAD underwent surgery using the aortic arch inclusion technique with frozen elephant trunk （FET） under moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion. Computed tomography angiography （CTA） was performed before discharge to evaluate surgery outcomes. Results In-hospital mortality was 5.4% （12/222）. Paraplegia occurred in 3 patients （1.4%） and stroke occurred in 9 patients （4,1%）, Mean cardiopulmonary bypass and circulatory arrest times were respectively 135.2±29.1 minutes and 37.5±7.1 minutes. Aortic arch false lumen closure rate was 81.8% and descending thoracic aorta thrombosis rate was 69.4% at discharge. Conclusions Aortic arch inclusion technique with FET provides a safe alternative to TAAD treatment, with satisfying operative results. Short-term follow up results are encouraging and long-term outcomes need further investigations.

关 键 词：STANFORD A型夹层 手术 主动脉弓修复术 内覆式技术 支架象鼻术 

分 类 号：R65[医药卫生—外科学]