急性A型主动脉夹层合并Neri C型冠状动脉受累细化分型的外科治疗策略  

Surgical Treatment Strategy for Acute Type A Aortic Dissection Complicated With Neri Type C Coronary Artery Involvement on the Basis of Detailed Classification

作　　者：朱贵军[1] 严哲[1] 刘阳[1] 宋志良 李斌[1] 陈兴澎[1] Zhu Guijun;Yan Zhe;Liu Yang(Heart Center,Luoyang Central Hospital,Zhengzhou University,Luoyang Clinical Research Center of Cardiothoracic Surgery,Luoyang 471009,China)

机构地区：[1]郑州大学附属洛阳市中心医院心脏中心洛阳市心胸外科临床研究中心,洛阳471009

出　　处：《中国微创外科杂志》2024年第11期731-736,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：2019河南省医学科技攻关项目(LHGJ20191213);2024河南省医学科技攻关计划联合共建项目(LHGJ20240735)。

摘　　要：目的探讨急性A型主动脉夹层(acute type A aortic dissection,ATAAD)合并Neri C型冠状动脉(冠脉)受累细化分型的外科治疗策略。方法回顾性分析我院2020年11月~2024年2月21例ATAAD合并Neri C型冠脉受累的病例资料。夹层累及冠脉,发病时间<1周,行全主动脉弓替换、降主动脉支架象鼻人工血管置入、升主动脉置换及冠脉处理。细化分型及冠脉处理方法:C1型(冠脉开口局部损伤破裂,与假腔部分连接,冠脉开口内外膜无分离)7例以人工材料“铜钱样”修复;C2型(冠脉开口严重损伤撕脱,与假腔完全连接,冠脉近段累及轻微,内外膜局部分离,未形成套袖)3例以8 mm人工血管置换;C3型(冠脉开口严重损伤撕脱,与假腔完全连接,冠脉近段累及严重,内外膜完全分离,且形成套袖)11例以大隐静脉旁路移植。结果院内死亡2例(均为C3型),均心脏复跳困难,体外膜氧合(extracorporeal membrane oxygenation,ECMO)辅助循环,分别于术后当天、第2天死亡。19例出院患者出院前复查主动脉及冠脉CTA,无冠脉开口狭窄和桥血管狭窄。术后6、12、18个月复查主动脉及冠脉CTA。19例随访6~36个月,平均21个月,无冠脉开口狭窄和桥血管狭窄病例。纽约心脏协会(NYHA)心功能分级Ⅰ级15例,Ⅱ级4例。结论ATAAD合并Neri C型冠脉受累的细化分型对外科实施精准治疗具有指导性意义。Objective To explore the surgical treatment strategy of acute type A aortic dissection(ATAAD)complicated with Neri type C coronary artery involvement on the basis of detailed classification.Methods Clinical data of 21 cases of ATAAD complicated with Neri type C coronary artery involvement in our hospital from November 2020 to February 2024 were retrospectively analyzed.The dissection involved the coronary artery,and the onset time was less than 1 week.Total aortic arch replacement,descending aorta stent and elephant trunk artificial vessel placement,ascending aorta replacement,and coronary artery management were performed.The treatment of detailed classification and coronary artery was as follows.Seven cases with type C1(local damage and rupture of coronary artery opening,partial connection with pseudolumen,and no proximal coronary involvement)were repaired with artificial material“copper coin sample”;3 cases with type C2(severe avulsion of coronary artery opening,complete connection with pseudolumen,slight proximal involvement of coronary artery,and no sleeve formation)were replaced with 8 mm artificial vessels;11 cases with type C3(severe avulsion of coronary artery opening,complete connection with pseudolumen,severe proximal involvement of coronary artery,and sleeve formation)were transplanted by great saphenous vein bypass.Results Two patients died in hospital(all type C3),all of whom had difficulty in cardioversion and were given extracorporeal membrane oxygenation(ECMO)assisted circulation,and passed away on the same day and the second day after surgery,respectively.Aortic and coronary CTA were re-examined in the remaining 19 patients before discharge,and no coronary artery opening stenosis or bridge stenosis was found.Aortic and coronary CTA were re-examined at 6,12,and 18 months after surgery,respectively.The 19 patients were followed up for 6-36 months(mean,21 months),and there were no cases of coronary artery opening stenosis or bridge stenosis.According to the New York Heart Association(NYHA)functi

关 键 词：Neri分型 冠状动脉 急性A型主动脉夹层 外科手术 

分 类 号：R654.3[医药卫生—外科学]