Stanford B型主动脉夹层腔内支架修复术后再发逆撕型A型主动脉夹层的外科治疗  

Surgical treatment of retrograde type A aortic dissection after thoracic endovascular aortic repair for Stanford type B aortic dissection

作　　者：陆杰 唐杨烽 谈梦伟 韩林 LU Jie;TANG Yangfeng;TAN Mengwei;HAN Lin(Department of Cardiovascular Surgery,Changhai Hospital,Naval Medical University,Shanghai,200433,P.R.China)

机构地区：[1]海军军医大学附属长海医院心血管外科,上海200433

出　　处：《中国胸心血管外科临床杂志》2023年第10期1440-1445,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81770477)。

摘　　要：目的探讨Stanford B型主动脉夹层腔内支架修复术后再发逆撕型A型主动脉夹层的原因及其外科治疗的临床疗效。方法回顾性分析2014年3月—2018年8月既往行腔内修复的Stanford B型主动脉夹层患者因再发逆撕型A型主动脉夹层于海军军医大学附属长海医院行外科手术患者的临床资料。出院患者均常规门诊复查和电话随访。结果共纳入16例患者,其中男13例、女3例,年龄(49.1±12.2)岁。再发A型夹层时症状为胸痛12例,头痛和意识障碍各1例,无症状2例。16患者均接受升主动脉置换,全弓置换加支架象鼻植入术。主动脉根部行Bentall手术2例,行根部成形术10例,行主动脉瓣置换术1例。术中发现夹层破口明确位于近端金属裸支架周围共10例,另外6例破口位于升主动脉前侧壁。术中体外循环时间为(152.2±29.4)min,主动脉阻断时间为(93.6±27.8)min,选择性脑灌注时间为(29.8±8.3)min。住院期间及术后30 d内无死亡。术后随访32~85(57.4±18.3)个月。随访期间均存活,1例于术后3年因腹主动脉夹层再次行腔内支架植入术。结论采用全弓置换合并支架象鼻技术是治疗Stanford B型夹层术后再发逆撕型A型主动脉夹层的合适策略。Objective To analyze the etiologies,surgical treatment and outcomes of retrograde type A aortic dissection(RTAD)after thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection.Methods The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed.All patients were followed-up by clinic interview or telephone.Results A total of 16 patients were enrolled,including 13 males and 3 females with a mean age of 49.1±12.2 years.The main symptoms of RTAD were chest pain in 12 patients,headache in 1 patient,conscious disturbance in 1 patient,and asymptomatic in 2 patients.All the 16 patients received total arch replacement with the frozen elephant trunk technique.Bentall procedure was used in 2 patients,aortic root plasticity in 10 patients and aortic valve replacement in 1 patient.The primary tear in 10 patients was located in the area which were anchored by bare mental stent,and in the other 6 patients it was located in the anterior part of ascending aorta.The mean cardiopulmonary bypass time was 152.2±29.4 min,aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min.There was no death in hospital or within postoperative 30 days.The follow-up period was 32-85(57.4±18.3)months.No death occurred during the follow-up period.One patient underwent TEVAR again 3 years after this operation and had an uneventful survival.Conclusion Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for Stanford type B aortic dissection.

关 键 词：胸主动脉腔内修复 逆撕型A型主动脉夹层 全弓置换 支架象鼻技术 

分 类 号：R654.3[医药卫生—外科学]