升主动脉置换+弓部覆膜支架三开窗手术治疗急性Stanford A型主动脉夹层的早期临床结果  

Short-term outcome of ascending aorta replacement combined with total aortic arch fenestration technique for acute type A aortic dissection

作　　者：马先桃 朱章强 冯异 李师亮 Wajeehullahi Akilu 魏翔[1] 程才[1] MA Xiantao;ZHU Zhangqiang;FENG Yi;LI Shiliang;Wajeehullahi Akilu;WEI Xiang;CHENG Cai(Department of Cardiac and Vascular Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,P.R.China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,武汉430030

出　　处：《中国胸心血管外科临床杂志》2022年第5期577-584,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的评价升主动脉置换+弓部覆膜支架三开窗手术用于治疗急性Stanford A型主动脉夹层的临床应用价值和手术效果。方法回顾性分析2016—2020年在华中科技大学同济医学院附属同济医院接受升主动脉置换+弓部覆膜支架三开窗手术治疗24例急性Stanford A型主动脉夹层患者的临床资料,其中男17例、女7例,年龄45~72岁。患者夹层均未累及弓上三分支动脉,所有患者均采用非深低温体外循环下行升主动脉人工血管置换,保留弓部及弓上三分支,个体化覆膜支架开窗植入术。结果所有患者手术成功率为100.0%,无术中并发症,术后1个月无内漏迹象。住院时间为(10±5)d。术后随访中支架通畅,无移位,保留的主动脉弓分支动脉通畅,降主动脉真腔扩大。结论应用升主动脉置换+弓部覆膜支架三开窗手术治疗急性Stanford A型主动脉夹层,可以在避免深低温停循环、缺血-再灌注损伤、头颈上肢缺血缺氧、手术时间过长等传统杂交手术方式弊端的同时,极大地简化手术方式、节省手术时间、降低死亡率和并发症发生率,具有非常理想的近期临床疗效,远期临床效果需要长期随访和大样本研究的验证。Objective To report our clinical experience and outcomes of thoracic endovascular aortic repair(TEVAR)for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique.Methods From 2016 to 2020 in our hospital,24 patients(17 males and 7 females,aged 45-72 years)with complicated Stanford type A aortic dissection,underwent replacement of the proximal ascending aorta with TEVAR.None of the patients with dissection involved the three branches of the superior arch,and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass,preserving the arch and the three branches above the arch,and individualized stent graft fenestration.Results Surgical technical success rate was 100.0%.There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively.Hospital stay was 10±5 d.During postoperative follow-up,the stent was unobstructed without displacement,the preserved branch of the aortic arch was unobstructed,and the true lumen of the descending aorta was enlarged.Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.

关 键 词：急性Stanford A型主动脉夹层 胸主动脉腔内修复术 开窗技术 血管内治疗 杂交手术 覆膜支架 

分 类 号：R654.3[医药卫生—外科学]