中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
9期
3764-3768
,共5页
詹必成%刘建%杜少鸣%陈剑%张凡
詹必成%劉建%杜少鳴%陳劍%張凡
첨필성%류건%두소명%진검%장범
动脉瘤,夹层%主动脉,胸%心血管外科手术
動脈瘤,夾層%主動脈,胸%心血管外科手術
동맥류,협층%주동맥,흉%심혈관외과수술
Aneurysm,dissecting%Aorta,thoracic%Cardiovascular surgical procedures
目的总结26例各型胸主动脉夹层的手术治疗经验。方法2008年8月至2012年6月手术治疗26例胸主动脉夹层患者，男22例，女4例，年龄36～69岁，平均（51.1±12.9）岁。 Stanford分型：A型10例，B型16例。 A型中行升主动脉及全弓置换加术中象鼻支架植入术6例，Bentall术1例，升主动脉置换术3例；B型中行降主动脉置换术2例，降主动脉覆膜支架腔内隔绝术（ EVGE）14例（其中1例2 d后再行腹主动脉置换术）。6例全弓置换脑保护采用深低温停循环（DHCA）加上腔静脉逆行灌注（RCP），1例降主动脉置换下半身供血采用左心转流。术后定期复查CTA。结果10例Standford A型患者死亡2例（20％），1例术中死于鱼精蛋白反应后大出血，另1例术中出血多，术后第1天死于多脏器衰竭，余治愈出院。16例B型患者死亡1例（6.2％），死于大出血，余均治愈出院。术后CTA显示人工血管血流通.，支架系统位置良好，无内漏，主动脉真腔较术前明显扩大，未闭的假腔血栓形成。结论手术是挽救主动脉夹层患者的重要手段，手术方式应根据破口特点及主动脉及其瓣膜具体情况来选择。全弓置换采用DHCA＋RCP脑保护效果良好。采用EVGE治疗Standford B型夹层手术时间短、创伤小、效果佳。
目的總結26例各型胸主動脈夾層的手術治療經驗。方法2008年8月至2012年6月手術治療26例胸主動脈夾層患者，男22例，女4例，年齡36～69歲，平均（51.1±12.9）歲。 Stanford分型：A型10例，B型16例。 A型中行升主動脈及全弓置換加術中象鼻支架植入術6例，Bentall術1例，升主動脈置換術3例；B型中行降主動脈置換術2例，降主動脈覆膜支架腔內隔絕術（ EVGE）14例（其中1例2 d後再行腹主動脈置換術）。6例全弓置換腦保護採用深低溫停循環（DHCA）加上腔靜脈逆行灌註（RCP），1例降主動脈置換下半身供血採用左心轉流。術後定期複查CTA。結果10例Standford A型患者死亡2例（20％），1例術中死于魚精蛋白反應後大齣血，另1例術中齣血多，術後第1天死于多髒器衰竭，餘治愈齣院。16例B型患者死亡1例（6.2％），死于大齣血，餘均治愈齣院。術後CTA顯示人工血管血流通.，支架繫統位置良好，無內漏，主動脈真腔較術前明顯擴大，未閉的假腔血栓形成。結論手術是輓救主動脈夾層患者的重要手段，手術方式應根據破口特點及主動脈及其瓣膜具體情況來選擇。全弓置換採用DHCA＋RCP腦保護效果良好。採用EVGE治療Standford B型夾層手術時間短、創傷小、效果佳。
목적총결26례각형흉주동맥협층적수술치료경험。방법2008년8월지2012년6월수술치료26례흉주동맥협층환자，남22례，녀4례，년령36～69세，평균（51.1±12.9）세。 Stanford분형：A형10례，B형16례。 A형중행승주동맥급전궁치환가술중상비지가식입술6례，Bentall술1례，승주동맥치환술3례；B형중행강주동맥치환술2례，강주동맥복막지가강내격절술（ EVGE）14례（기중1례2 d후재행복주동맥치환술）。6례전궁치환뇌보호채용심저온정순배（DHCA）가상강정맥역행관주（RCP），1례강주동맥치환하반신공혈채용좌심전류。술후정기복사CTA。결과10례Standford A형환자사망2례（20％），1례술중사우어정단백반응후대출혈，령1례술중출혈다，술후제1천사우다장기쇠갈，여치유출원。16례B형환자사망1례（6.2％），사우대출혈，여균치유출원。술후CTA현시인공혈관혈류통.，지가계통위치량호，무내루，주동맥진강교술전명현확대，미폐적가강혈전형성。결론수술시만구주동맥협층환자적중요수단，수술방식응근거파구특점급주동맥급기판막구체정황래선택。전궁치환채용DHCA＋RCP뇌보호효과량호。채용EVGE치료Standford B형협층수술시간단、창상소、효과가。
Objective To summarize the surgical experience of 26 cases with aortic dissection . Methods From August 2008 to June 2012,26 patients with aortic dissection underwent surgery ,included 22 males and 4 females,the age was from 36 to 69 years with an average of (51.1 ±12.9 ) years,Stanford A in 10 cases, Stanford B in 16 cases.Surgical procedures in Stanford A cases included ascending and total arch replacement with stent elephant trunk surgery in 6 cases, ascending aortic replacement in 3 cases, Bentall surgery in one case .In Stanford B cases included discending aortic repalcement in 2 cases, thoracic endovascular stent-graft exclusion (EVGE)in 14 cases(abdominal aortic replacement 2 days later in one case).The brain protections were performed under deep hypothermic circulatory arrest ( DHCA ) and retrograde cerebral perfusion ( RCP ) in ascending and total arch replacement with stent elephant trunk surgery .The follow-up computed tomography angiography ( CTA ) was examinated regularly.Results Operative mortality was 20%(2/10)in Stanford A cases,one case died of protamine response ,the other died of bleeding .Operative mortality was 6.2%( 1/16 ) in Stanford B cases , died of bleeding . Follow-up CTA displayed artificial vessel were unobstructed ,the endovascular stents were fixed well with no leakage , the ture lumen enlarged and false lumen thrombosed and shrinked .Conclusions Surgery is an important method to save the patients with aortic dissection , the choise of surgical procedures depend on the location of intimal tear of aortic dissection .Proper surgical indication , technique and brain protections are the key factors of aortic dissection surgery.DHCA+RCP is an effective brain protection in total arch replacement .EVGE is a minimally invasive, effective,safe surgery in treating Standford type B aortic dissection .
