两种术式治疗Stanford A型主动脉夹层的病例对照研究  

Different surgical procedures for Stanford type A aortic dissection: A case control study

作　　者：赵应录 王玮璠[1] 王炜[1] 贺逢孝 王石雄[1] 薛羽[1] 马麒[1] 高秉仁[1] 柳德斌[1] ZHAO Yinglu;WANG Weifan;WANG Wei;HE Fengxiao;WANG Shixiong;XUE Yu;MA Qi;GAO Bingren;LIU Debin(Department of Cardiac Surgery,the Second Hospital of Lanzhou University,Lanzhou,730030,P.R.China)

机构地区：[1]兰州大学第二医院心脏外1科

出　　处：《中国胸心血管外科临床杂志》2019年第7期664-669,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省自然科学基金项目(1506RJZA256);兰州大学第二医院萃英创新项目(CY2017-BJ01);兰州大学第二医院萃英科技创新项目,(CY2017-MS07)兰州市人才创新创业项目(2017-RC-63)

摘　　要：目的分析孙氏手术与去分支复合手术两种不同术式治疗Stanford A型主动脉夹层采的近、中期疗效。方法回顾性分析2014年9月至2017年9月我院确诊为Stanford A型主动脉夹层行外科手术治疗46例患者的临床资料,其中男39例、女7例,年龄20~74(48.67±11.80)岁。据手术方式将患者分为孙氏手术组(26例)和去分支复合手术组(20例),比较两组临床结果。结果去分支复合手术组在体外循环(cardiopulmonary bypass time,CPB)时间、主动脉阻断(aortic cross clamp,ACC)时间、术中尿量、术后呼吸机辅助呼吸时间、术后24h引流液量、监护病房停留时间较孙氏手术组有明显优势(P<0.05)。术后暂时性神经系统功能损害发生率低于孙氏手术组(P<0.05)。术后随访时间3~36个月,随访率为90.5%。孙氏手术组1例术后30d死于肺部严重感染,去分支复合手术组1例患者在术后早期复查时发现内漏,6个月后复查时内漏消失。孙氏手术组未出现内漏。随访期间所有患者均未出现脑卒中、凝血功能障碍、截瘫、上肢缺血等并发症。结论对于StanfordA型主动脉夹层,去分支复合手术虽然有术后发生内漏风险,但整体疗效较之孙氏手术有一定优越性,故而对于此型夹层的治疗可优先选择去分支复合手术。Objective To analyze the near-term clinical efficacy of two different surgical procedures (Sun's procedure and Debranching combined endovascular stent-graft procedure) to cure Stanford type A aortic dissection, and summarize the clinical experience to help better master the indications of the two surgical procedures. Methods We retrospectively analyzed the clinical data of 46 patients with Stanford A aortic dissection in our hospital between September 2014 and September 2017. There were 39 males and 7 females at age of 20–74 (48.67±11.80) years. According to different surgical methods, the patients were divided into a Sun's procedure group (26 patients) and a debranching combined endovascular stent-graft procedure group (20 patients). The clinical effect of the two groups was compared. Results The debranching combined endovascular stent-graft procedure group was significantly superior to the Sun's group in cardiopulmonary bypass (CPB) time, aortic cross clamp(ACC) time, intraoperative urine output, postoperative mechanical ventilation time, postoperative 24 h volumes of drain, CICU time, renal function recovery of postoperative 72 h and total hospital stay(P<0.05). The incidence of transient neurological damage after operation in the debranching combined endovascular stent-graft procedure group was significantly lower than that of the Sun's procedure group(P<0.05). The follow-up time ranged from 3 to 36 months. And the follow-up rate was 90.5%. One patient in the Sun's procedure group died of serious pulmonary infection postoperative 30 days. One patient in the debranching combined endovascular stent-graft group was found to have internal leakage in the early postoperative examination and disappeared after 6 months. Sun's procedure group did not find endoleak. All patients during the follow-up time did not appear brain, coagulation disorders, stroke, paraplegia, upper limb ischemia and other complications. Conclusion For Stanford type A aortic dissection, debranching combined surgery may have the risk of posto

关 键 词：孙氏手术 主动脉弓去分支 腔内隔缘术 A型主动脉夹层 

分 类 号：R654.3[医药卫生—外科学]