CAJ | 학술논문

目的：探讨Stanford A型主动脉夹层的诊断及其外科治疗。方法1994年1月-2013年12月手术治疗的Stanford A型主动脉夹层15例，经增强血管CT（CTA）、磁共振扫描（MRI）、超声心动图（UCG）确诊。右腋动脉及腔房管插管建立体外循环。Bentall手术8例，Bentall手术加半弓置换4例，Bentall手术加主动脉弓全弓置换及术中降主动脉支架置入术（孙氏手术）3例。结果平均体外循环时间（142.6±16.3）min，平均心肌阻断时间（80.2±9.5）min，停循环选择性脑灌注时间（20.1±6.7）min。死亡1例。结论外科手术是治疗Stanford A型主动脉夹层较为理想的方法；尽早诊断及手术，消除假腔、置换病变血管、重建分支血管是手术的基本原则。
목적：탐토Stanford A형주동맥협층적진단급기외과치료。방법1994년1월-2013년12월수술치료적Stanford A형주동맥협층15례，경증강혈관CT（CTA）、자공진소묘（MRI）、초성심동도（UCG）학진。우액동맥급강방관삽관건입체외순배。Bentall수술8례，Bentall수술가반궁치환4례，Bentall수술가주동맥궁전궁치환급술중강주동맥지가치입술（손씨수술）3례。결과평균체외순배시간（142.6±16.3）min，평균심기조단시간（80.2±9.5）min，정순배선택성뇌관주시간（20.1±6.7）min。사망1례。결론외과수술시치료Stanford A형주동맥협층교위이상적방법；진조진단급수술，소제가강、치환병변혈관、중건분지혈관시수술적기본원칙。
ObjectiveWe attempted to study the diagnosis and surgical treatment of Stanford type A aortic dissection, a serious and complicated disease.Methods15 cases of Stanford type A aortic dissection received surgical treatment from January 1994 to December 2013, and their diagnosis was made by CTA, MRI and UCG. Right subclavian arterial cannulation and cavoatrial cannulation were used to set up cardiopulmonary bypass, and deep hypothermic circulation arrest with selective cerebral perfusion was employed in 3 cases of aortic arch replacement and endovascular stent repair. Different operations were adapted according to the rupture site, dissecting extent and aortic valve regurgitation: including Bentall(8 cases), Bentall with partial arch replacement (4 cases), Bentall with arch replacement and stented elephant truck (SUN’s procedure,3 cases).ResultsThe average CPB time was (142.6±16.3) min, clamp time was (80.2±9.5) min, and circulation arrest time was (20.1±6.7) min. There was one death.ConclusionSurgical treatment of Stanford type A aortic dissection significantly reduced the mortality. The basic surgical principle is to eliminate false lumen, then to replace dissecting aorta and to reestablish blood supply of aortic branches.