喀什地区A型主动脉夹层外科治疗初步经验  

Preliminary surgical experience of type A aortic dissection in Kashi district

作　　者：刘思明 吕会斌 伊力哈木江·阿卜杜尼亚孜 麦麦提艾力·麦麦提 阿布都外里·热合曼 辛映旭 田爱丽 朱家全[1] LIU Si-ming;LYU Hui-bin;Yilihamujiang ABODUNIYAZI;Maimaitiaili MAIMAITI;Abuduwaili REHEMAN;XIN Ying-xu;TIAN Ai-li;ZHU Jia-quan(Department of Cardiothoracic Surgery,Xinhua Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai 200092,China;Department of Cardiothoracic Surgery,The Second People’s Hospital of Kashi,Kashi 844099,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092 [2]新疆维吾尔自治区喀什地区第二人民医院心胸外科

出　　处：《中国心血管病研究》2025年第4期354-358,共5页Chinese Journal of Cardiovascular Research

基　　金：上海市科委“科技创新行动计划”国内科技合作领域项目(23015830200)。

摘　　要：目的 总结喀什地区第二人民医院近年开展A型主动脉夹层外科手术的初步经验。方法 回顾性分析2023年5月至2024年11月期间70例A型主动脉夹层手术病例。手术由同一团队完成,早中期病例由上海援疆专家主刀,中后期部分病例由其带教的喀什本地专家主刀。收集围术期资料,并对两位主刀医生的病例进行对比,分析带教效果。结果 本组患者平均年龄(49.7±10)岁,男性57例(81.6%)。主动脉根部处理时,29例患者行主动脉窦部成形、升主动脉置换,40例行主动脉根部置换,1例行Wheat手术。弓部处理时,55例行全主动脉弓置换,8例行部分主动脉弓置换,7例弓部无需处理。降主动脉处理方面,53例放置单分支象鼻支架,2例采用经典软象鼻技术,15例无需处理。中位停循环脑灌注时间35(29,39)min,中位主动脉阻断时间为175(150,196)min,中位体外循环时间为284(244,323)min。术后中位呼吸机辅助时间为91(32,181)h,中位ICU停留6(4,9)d,术后中位住院19(13,28)d。围术期并发症包括7例急性肾衰竭需血透治疗,2例神经系统并发症,6例再手术。全组共14例(20%)死亡或自动出院,体外循环时间与围术期死亡呈正相关。本地专家主刀21例(30%),两位术者医师的患者结局类似,但本地专家的停循环脑灌注时间显著长于上海援疆专家(P=0.004)。结论 喀什地区已具备手术治疗急性A型主动脉夹层的能力,通过援疆帮扶,当地专家已初步掌握该项手术技术。总体手术结果良好,但仍与国内外顶尖医疗中心存在差距,有进一步提高的空间。Objective We summarize the preliminary surgical experiences of Type A aortic dissection from the Second People's Hospital of Kashi.Methods The 70 patients who underwent surgery of Type A aortic dissection between May 2023 and November 2024 were retrospectively analyzed.All the surgeries were performed by a same surgical team.In the early era,the patients were operated by Shanghai expert,during the late era,some patients were operated by local expert.The perioperative data were collected,and they were compared between the two surgeons in order to analyze teaching effect.Results The average age was 49.7 ± 10 years.There were 57males(81.6%).The reinforcement of aortic root was performed in 29 patients,the aortic root replacement was performed in 40 patients,while the Wheat procedure was done in 1 patient.Total aortic arch replacement was performed in 55 patients,and partial arch replacement was performed in 8 patients,no arch surgery was needed in the rest 7 patients.Frozen elephant trunk surgery was applied in 53 patients,classic elephant trunk technique was used in 2 patients,while the other 15 patients didn't had surgery on descending aorta.The median anterior cerebral perfusion time during circulatory arrest was 35(29,39) minutes,the median aortic cross clamp time was 175(150,196) minutes,and the median cardiopulmonary bypass time was 284(244,323) minutes.The median mechanical ventilation time after surgery was 91(32,181) hours,and the median ICU stay was 6(4,9) days.The median postoperative hospital stay was 19(13,28) days.Peri-operative complications included acute renal failure requiring hemodialysis in 7 patients,neurological defect in 2 patients,and re-exploration in 6 patients.In total,there were 14 deaths or withdrawing(20%).The cardiopulmonary bypass time was positively correlated with perioperative death.The local surgeon operated 21 cases(30%).The outcomes between the two surgeons were similar,while the circulatory arrest with cerebral perfusion time was significantly longer in the local expert group

关 键 词：A型主动脉夹层 心外科手术 预后 

分 类 号：R543.1[医药卫生—心血管疾病]