合并肠系膜灌注不良的急性Stanford A型主动脉夹层的治疗策略  

Management of acute type A aortic dissection with mesenteric malperfusion

作　　者：周越赟 秦卫[1] 李健[1] 苏存华[1] 王晓棣[1] 黄福华[1] Zhou Yueyun;Qin Wei;Li Jian;Su Cunhua;Wang Xiaodi;Huang Fuhua(Department of Thoracic and Cardiovascular Surgery,Nanjing First Hospital,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院、南京市第一医院心胸血管外科,210006

出　　处：《中华胸心血管外科杂志》2023年第10期605-609,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金青年基金项目(81900417)

摘　　要：目的总结合并肠系膜灌注不良的急性Stanford A型主动脉夹层患者的治疗策略及结果。方法回顾南京市第一医院2019年1月至2022年9月接受急诊手术治疗的321例急性Stanford A型主动脉夹层患者资料,根据术前主动脉CTA结合腹部临床症状筛选出13例合并肠系膜灌注不良的患者。记录患者的基本信息、术前的合并症及特定并发症。评估临床结果,包括术后胃肠道并发症、其他并发症、住院期间病死率以及晚期结局等,进而分析治疗策略。结果2例在杂交手术室采用肠系膜上动脉血运重建优先策略;11例采用中心主动脉修复优先策略,其中2例完成中心修复后行肠系膜上动脉造影。13例患者均行全弓替换术。2例肠系膜血运重建优先患者术后未出现胃肠道并发症;11例中心修复优先患者中8例出现不同程度胃肠道并发症,其中2例接受额外的胃肠道开放手术。6例住院期间死亡;7例生存患者出院后随访,目前仍生存。结论合并肠系膜灌注不良的急性A型夹层患者,建议优先重建肠系膜上动脉血供随后立即行中心主动脉修复,对于因合并冠状动脉、脑灌注不良或血流动力学不稳定而优先行中心修复的患者,术后需行肠系膜上动脉造影评估。Objective To summarize treatment strategies and outcomes of patient suffer from acute Stanford type A aortic dissection(ATAAD)with mesenteric malperfusion.Methods We collected 13 patients with mesenteric malperfusion among 321 ATAAD patients underwent surgery at Nanjing First Hospital during January 2019 to September 2022.Characteristics of these patients were recorded.We analyzed their early and late clinical outcomes.Results Two patients underwent revascularization-first strategy in hybrid operation room had no in-hospital mortality or complication related to mesenteric ischemia.There were 11 patients with central repair-first strategy.Eight patients appeared mesenteric complications and 2 of them needed extra gastrointestinal surgery.Six in-hospital mortality were recorded in central repair-first patients.Conclusion We recommended revascularization-first strategy with followed central repair in hybrid operation room for patients suffered from ATAAD with mesenteric malperfusion.Those who underwent central repair-first strategy because of coronary artery or cerebral malperfusion and unstable hemodynamic needed percutaneous angiography of mesenteric artery.

关 键 词：急性A型主动脉夹层 肠系膜灌注不良 血运重建优先 杂交手术室 

分 类 号：R654[医药卫生—外科学]