CAJ | 학술논문

目的探讨三分支覆膜支架重建主动脉弓部手术治疗Stanford A型主动脉夹层的疗效,并与传统的全弓置换+象鼻支架置入术进行疗效的比较.方法自2006年1月至2011年5月,对28例Stanford A型主动脉夹层患者行手术治疗,其中20例患者以全弓置换+象鼻支架置入术治疗(Ⅰ组),8例患者以三分支覆膜支架重建主动脉弓部手术治疗(Ⅱ组).术前均行超声心动图、主动脉CT血管造影检查.术后1个月进行临床随访和超声心动图、主动脉CT血管造影复查.结果两组患者的年龄、性别和病情差异无统计学意义(P均＞0.05).患者手术全部成功,无死亡病例.Ⅰ组的体外循环时间、心肌阻断时间、停循环或选择性脑灌注时间、术后引流量、术后呼吸机辅助呼吸时间、输血量和住院费用均多于Ⅱ组(P均＜0.05).术后1个月,Ⅰ组胸主动脉最大内径小于术前[ (30.2 ±3.1)mm比(42.5±6.5) mm,p＜0.05],Ⅱ组胸主动脉最大内径也小于术前[(31.5±2.5) mm比(44.1±7.3)mm,P＜0.05];两组患者左心室射血分数与术前比较差异均无统计学意义(P均＞0.05).结论三分支覆膜支架重建主动脉弓部手术和全弓置换+象鼻支架置入术治疗Stanford A型主动脉夹层均有良好的近期临床疗效,前者简化了手术步骤,缩短了手术时间,减少了输血量、术后引流量及住院费用.
목적 탐토삼분지복막지가중건주동맥궁부수술치료Stanford A형주동맥협층적료효,병여전통적전궁치환+상비지가치입술진행료효적비교.방법 자2006년1월지2011년5월,대28례Stanford A형주동맥협층환자행수술치료,기중20례환자이전궁치환+상비지가치입술치료(Ⅰ조),8례환자이삼분지복막지가중건주동맥궁부수술치료(Ⅱ조).술전균행초성심동도、주동맥CT혈관조영검사.술후1개월진행림상수방화초성심동도、주동맥CT혈관조영복사.결과 량조환자적년령、성별화병정차이무통계학의의(P균＞0.05).환자수술전부성공,무사망병례.Ⅰ조적체외순배시간、심기조단시간、정순배혹선택성뇌관주시간、술후인류량、술후호흡궤보조호흡시간、수혈량화주원비용균다우Ⅱ조(P균＜0.05).술후1개월,Ⅰ조흉주동맥최대내경소우술전[ (30.2 ±3.1)mm비(42.5±6.5) mm,p＜0.05],Ⅱ조흉주동맥최대내경야소우술전[(31.5±2.5) mm비(44.1±7.3)mm,P＜0.05];량조환자좌심실사혈분수여술전비교차이균무통계학의의(P균＞0.05).결론 삼분지복막지가중건주동맥궁부수술화전궁치환+상비지가치입술치료Stanford A형주동맥협층균유량호적근기림상료효,전자간화료수술보취,축단료수술시간,감소료수혈량、술후인류량급주원비용.
Objective To compare the clinical efficacy between total aortic arch reconstruction with open triple-branched stent graft placement and total aortic replacement combined with stented elephant trunk implantation for patients with Stanford A aortic dissection.Methods Patients with Stanford A aortic dissection treated with surgical treatment from January 2006 to May 2011 were included in this study.The patients were divided into two groups.Group Ⅰ (n =20) patients were treated by total arch replacement with stented elephant trunk procedure.Group Ⅱ (n =8 ) patients received open triple-branched stent graft placement. Echocardiography and aortic CT angiography were performed before and at 1 month after operation.Results Age,gender and disease severity were similar between the 2 groups ( all P ＞ 0.05 ).Operation was successful in all 28 patients.Cardiopulmonary bypass time,aortic cross clamp time,circulation arrest time and duration of ventilator assisted breathing were significantly longer; postoperative drainage volume and blood transfusion volume were significantly larger and hospitalization cost was significantly higher in group Ⅰ patients compared those in group Ⅱ patients ( all P ＜ 0.05 ). One month after operation,the maximum internal diameter of aorta was smaller than pre-operation in both group Ⅰ [ (30.2 ± 3.1 ) mm vs.(42.5 ±6.5)mm,P ＜ 0.05] and group Ⅱ [(31.5 ±2.5) mm vs.(44.1 ±7.3)mm,P ＜ 0.05].Conclusions Short-term procedural success rate was similar between the two groups.The total aortic arch reconstruction with open triple-branched stent graft placement procedure is simpler,shortens the operation time,reduces the blood transfusion volume and is more cost-effective compared to the classical aortic arch operation.