急性Stanford A型主动脉夹层术中应用三明治技术行主动脉根部重建近期疗效观察  

Short-term efficacy of Sandwich technique in aortic root reconstruction on Stanford type A acute aortic dissection

作　　者：宋鹏[1] 李继峰 梁志强[1] 何发明[1] 郭迎春[1] 崔聪[1] 王克学[1] SONG Peng;LI Ji-feng;LIANG Zhi-qiang;HE Fa-ming;GUO Ying-chun;CUI Cong;WANG Ke-xue(Department of Cardiovascular Surgery,Henan Provincial Chest Hospital,Chest Hospital of Zhengzhou University,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省胸科医院郑州大学附属胸科医院心血管外科,河南郑州1450000

出　　处：《中华实用诊断与治疗杂志》2023年第3期239-242,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220229)。

摘　　要：目的观察急性Stanford A型主动脉夹层术中应用三明治技术行主动脉根部重建的效果,探讨其安全性。方法急性Stanford A型主动脉夹层患者246例,均行急诊开胸手术治疗,术中应用三明治技术行主动脉根部重建。术后即刻行主动脉CT血管造影观察主动脉根部人工血管形态及有无假腔等,行心脏超声检查记录主动脉窦部直径、主动脉瓣返流量。记录手术时间、体外循环时间、阻断时间、深低温停循环时间、住院时间;比较手术前后主动脉窦部直径、主动脉瓣返流量;记录住院期间二次开胸止血、气管切开、神经系统并发症等发生和死亡情况。结果246例中行单纯升主动脉置换术2例,升主动脉置换+右半弓置换术31例,升主动脉置换+全弓置换+象鼻支架术213例,均顺利完成手术,术中无大出血、急性心力衰竭等发生。手术时间(398.22±99.87)min,体外循环时间(203.30±52.36)min,阻断时间(108.06±27.54)min,深低温停循环时间(20.37±7.48)min,住院时间(20.92±9.22)d。术后主动脉根部CT血管造影未发现残留假腔、主动脉根部形态良好、支架无内漏;术后主动脉窦部直径[(36.06±4.41)mm]、主动脉瓣返流量[(0.62±1.12)cm^(2)]均小于术前[(38.83±4.33)mm、[(3.21±3.03)cm^(2)](t=11.729,P<0.001;t=14.266,P<0.001)。术后院内死亡18例(7.3%),二次开胸止血8例(3.3%),行血液透析22例(8.9%),气管切开6例(2.4%),发生神经系统并发症12例(4.8%)。结论急性Stanford A型主动脉夹层患者应用三明治技术行主动脉根部重建近期疗效确切,安全性高,未增加术后并发症的发生。Objective To observe the efficacy of intraoperative application of Sandwich technique for aortic root reconstruction in patients with Stanford type A acute aortic dissection and to investigate its safety.Methods Totally 246 patients with Stanford type A acute aortic dissection received emergency thoracotomy,while Sandwich technique was applied to reconstruct the aortic root,and postoperative aortic CT angiography was performed to observe the morphology of the artificial vessels in the aortic root and the presence of false lumen.Echocardiography was performed to record the internal diameter of the aortic sinus and the aortic regurgitant flow.The operation lasting time,extracorporeal circulation time,blocking time,deep hypothermia circulation arrest time and length of hospital stay were recorded.The internal diameter of the aortic sinus and aortic regurgitation flow were compared before and after operation.The occurrence of complications such as secondary thoracotomy hemostasis,tracheotomy,neurological complications and death during hospitalization was recorded.Results In 246 patients,2 were performed ascending aortic replacement,31 were performed ascending aortic replacement+right hemiarch,and 213 were performed ascending aortic replacement+total arch replacement+elephant trunk stent,all of which were completed successfully in(398.22±99.87)min,with the extracorporeal circulation time of(203.30±52.36)min,blocking time of(108.06±27.54)min,deep hypothermic circulation arrest time of(20.37±7.48)min,and hospitalization time of(20.92±9.22)d,with no massive bleeding or acute heart failure.Postoperative CT angiography of the aortic root revealed no residual false lumen,good morphology of the aortic root,and no endoleakage of the stent.The internal diameter of the aortic sinus and the aortic regurgitation flow were smaller after operation[(36.06±4.41)mm,(0.62±1.12)cm^(2)]than those before operation[(38.83±4.33)mm,(3.21±3.03)cm^(2)](t=11.729,P<0.001;t=14.266,P<0.001).Eighteen patients died after operation in hospit

关 键 词：急性A型主动脉夹层 三明治技术 主动脉根部重建 

分 类 号：R654.3[医药卫生—外科学]