CAJ | 학술논문

目的总结Standford A型主动脉夹层的外科治疗经验.方法 2001年1月至2006年12月共收治Standford A型夹层动脉瘤患者54例,急性夹层(发病＜2周)36例,慢性夹层18例.46例接受手术治疗,其中急诊手术(入院后24 h内)35例,择期或限期手术11例;未行手术治疗8例.按主动脉根部术式分为单纯升主动脉置换术9例,Bentall术11例,Wheat+升主动脉置换术12例,David+升主动脉置换术14例.主动脉弓降部术式包括右半主动脉弓置换术6例,四分支人造血管全弓置换术25例,支架象鼻术24例.合并冠状动脉粥样硬化性心脏病及右冠状动脉断裂各1例,行冠状动脉旁路移植术.涉及主动脉弓部手术患者采用深低温停循环+双侧顺行选择性脑灌注,非急诊病例辅以体表降温.结果手术组死亡率8.7%(4/46),未手术组死亡率75.0%(6/8).围手术期并发精神症状1例,胸腔积液或心包积液3例,声音嘶哑1例,切口愈合不良1例,经过积极处理后所有患者均痊愈出院.出院患者随访2～70个月,平均(13.0±14.2)个月,生活质量良好.结论 Standford A型主动脉夹层应积极手术治疗,术中根据不同情况采取最佳术式及合适的脑保护方案,术后及时处理并发症,可以取得良好的效果.
목적 총결Standford A형주동맥협층적외과치료경험.방법 2001년1월지2006년12월공수치Standford A형협층동맥류환자54례,급성협층(발병＜2주)36례,만성협층18례.46례접수수술치료,기중급진수술(입원후24 h내)35례,택기혹한기수술11례;미행수술치료8례.안주동맥근부술식분위단순승주동맥치환술9례,Bentall술11례,Wheat+승주동맥치환술12례,David+승주동맥치환술14례.주동맥궁강부술식포괄우반주동맥궁치환술6례,사분지인조혈관전궁치환술25례,지가상비술24례.합병관상동맥죽양경화성심장병급우관상동맥단렬각1례,행관상동맥방로이식술.섭급주동맥궁부수술환자채용심저온정순배+쌍측순행선택성뇌관주,비급진병례보이체표강온.결과 수술조사망솔8.7%(4/46),미수술조사망솔75.0%(6/8).위수술기병발정신증상1례,흉강적액혹심포적액3례,성음시아1례,절구유합불량1례,경과적겁처리후소유환자균전유출원.출원환자수방2～70개월,평균(13.0±14.2)개월,생활질량량호.결론 Standford A형주동맥협층응적겁수술치료,술중근거불동정황채취최가술식급합괄적뇌보호방안,술후급시처리병발증,가이취득량호적효과.
Objective To summarize the surgical experience of type A aortic dissection.Methods From January 2001 to December 2006,54 cases were admitted for Standford type A aortic dissection,including 36 cases of acute aortic dissection and 18 cases of chronic.Thirty-five cases underwent emergence operation and 11 cases underwent selective/limited operation.while 8 cases received medical treatment.According to the modus operandi of root of aorta,9 cases underwent ascending aorta replacement merely,11 cases for Bentall operation,12 cases for Wheat operation and ascending aorta replacement,14 cases for David operation and ascending aorta replacement.According to the modus operandi of aortic arch and descendens,6 cases underwent risht hemiarch replacement,25 cases for total arch replacement with four branches aortic graft,24 cases for stent-graft elephant trunk technique.One patient of coronay heart disease and 1 patient of right coronary fracture underwent coronary artery bypass grafting.Deep hyperthermic circulatory arrest and antegrade selective cerebral perfusion were applied with aortic arch operation.Surface cooling was applied with selective/limited operation.Results Four patients died in operation group(8.7%)and 8 died in nonoperation group(75.0%).Postoperative complication included 1 mental symptom,3pleural/pericardial effusion,1 hoarseness,1 sternal rupture and poor wound healing.All the complication were cured.The operative out-hospital patients were followed up(13.0±14.2)months and the quality of life Was satisfied.Conclusions Standford type A aortic dissection should be operated aggressively.Expectable outcome could be acquired with optimum modus operandi,proper cerebral protection and dealing with postoperative complication timely.