Bentall术后StanfordA型主动脉夹层手术治疗  

Sun＇ s procedure for type A aortic dissection involving aortic arch after Bentall

作　　者：陈彧[1] 马维国[1] 李建荣[1] 郑军[1] 朱俊明[1] 刘永民[1] 孙立忠[1] Chen Yu;Ma Weiguo;Li Jianrong;Zheng Jun;Zhu Junming;Liu Yongmin;San Lizhong(Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood I/essel Diseases, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing Engi- neering Research Center for Vascular Prostheses, Beijing 100029, China)

机构地区：[1]北京首都医科大学附属北京安贞医院、北京市心肺血管疾病研究所、北京市大血管疾病诊疗中心心外一科、北京市大血管外科植入式人工材料工程技术研究中心,100029

出　　处：《中华胸心血管外科杂志》2018年第6期344-349,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家科技支撑计划课题（2015BAI12803）

摘　　要：目的探讨应用主动脉全弓替换结加支架象鼻手术（孙氏手术）治疗Bentall术后未手术部位新发A型主动脉夹层累及主动脉弓病变的中远期预后。方法回顾分析2009年2月至2016年2月141例StanfordA型主动脉夹层累及弓部病变的Marfan综合征（MFS）患者资料，11例（7．8％）初次因主动脉根部瘤行Bentall手术，其中男10例，年龄（43．2±8．6）岁（26～50岁），急诊手术8例，高血压病史4例，家族发病史7例，均行孙氏手术治疗。Bentall手术至孙氏手术时间间隔（11．3±5．8）年。依据术前降主动脉近端直径是否大于〉40mm分两组。收集所有患者围手术期临床资料和主动脉CTA影像学资料，分析孙氏手术后远端主动脉假腔血栓化程度、主动脉直径变化，远端主动脉扩张和再次手术等早期和中远期预后。结果11例Bentall术后合并StanfordA型主动脉夹层MFS患者均成功行孙氏手术治疗，无脊髓损伤。术前降主动脉近端直径〉40inln组患者住院死亡3例，其中1例手术时间长，肺实变合并多脏器功能衰竭；1例围手术期脑梗塞并脑出血；1例远端主动脉破裂。孙氏手术后随访（5．3±2．0）年（2．1～8．1年），随访率100％。远端主动脉假腔血栓化率在支架象鼻近端周围达100％，非支架降主动脉段达75．0％；支架近端无内漏，无远端主动脉破裂。3例远端主动脉缓慢扩张，最大直径达50him，拟择期行胸腹主动脉替换手术（TAAAR）术。晚期非心脏原因死亡2例，无再次手术。术前降主动脉近端直径〉40mill组与≤40mm组相比，FET支架段降主动脉重塑不明显，差异有统计学意义（P=0．01），在非支架降主动脉段，膈肌和肾动脉水平两组直径差异无统计学意义。Kaplan—Meier生存分析显示，孙氏手术后1个月、1年和6年生存率分别为81．8％，72．7％和63．6％。结论孙氏手术治疗Bentall术后远端未手术部Objective Stanford type A aortic dissection（TAAD） involving aortic arch in following prior Bentall proce- dure in patients with Maffan syndrome（MFS） is uncommon. The purpose of the study was to assess the early and long-term out- comes of this kind of patients underwent total arch replacement and frozen elephant trunk（TAR ＋ FET）. Methods Between February 2009 and February 2016, 141 patients with Marian syndrmne（confirmed by revised Ghent Criteria） underwent TAR ＋ FET for TAAD, of those 11 （7.8 % ） patients （8 acute） following a prior Bentall procedure and without dissection in distal a- orta. Mean age at FET was（43.2±8.6） years and 10 were males. Hypertension was seen in 4（36.4% ） and family history was seen in 7 （63.6%）. The interval from Bentall procedure to FET averaged （ 11.3 ± 5.8 ） years. Two groups were segregated by the maximal diameter of descending aorta more than 40 mm or not. The early and long-ternl outcomes were analyzed and risk factors identified for late adverse events. Results Operative mortality was 27.3% （3/11）. No spinal cord injury occurred. The cause of death was long time of surgery, muhinrgan failure, stroke and cerebral hemorrhage and rupture of distal aorta. Follow-up was complete in 100%, averaging（5.3 ± 2.0）years（ range 2.1 -8. 1 years）. Obliteration of the false lumen wasseen in 100% across the proximal FET and 75.0% in the unstented descending aorta. Distal aortic dilation occurred in 3 pa- tients which were waiting open thoracoabdominal aortic repair（TAAAR） but no reoperation yet. Of those 8 patients, 2 died of non-cardiac reason. The DMax of FET segment has significant grow in DA more than 40mm group than less than 40mm group （P= 0.01 ）. Another segment of distal aorta has no significant different. Survival were 81.8%, 72.7% and 63.6% at 1 month, 1 year and 6 years after surgery. Conclusion Using Sun＇ s procedure for Marfan patients for type A aortic dissection involving aortic arch following previous Bentall pro

关 键 词：孙氏手术 STANFORD A型主动脉夹层 Bentall术后 Maffan综合征 

分 类 号：R654.3[医药卫生—外科学]