CAJ | 학술논문

目的探讨Stanford A型主动脉夹层根部处理的方法及疗效评价.方法回顾性分析2001年1月至2011年6月接受治疗的161例Stanford A型主动脉夹层患者的临床资料.男性122例,女性39例；平均年龄(44±21)岁.急性主动脉夹层146例,慢性主动脉夹层15例.主动脉根部均有不同程度的病变,其中左冠状动脉-无冠状动脉和(或)右冠状动脉-无冠状动脉交界撕脱140例,主动脉瓣中度以上反流75例,主动脉窦部内膜破口15例,左或右冠状动脉撕脱8例,左或右冠状动脉夹层16例,合并主动脉根部瘤31例.结果本组患者行主动脉根部置换(Bentall术)72例,主动脉根部重建(包括主动脉瓣置换术)80例,David手术9例.主动脉根部重建组心肺转流时间小于主动脉根部置换组及David手术组[(193±42) min,(210 ±61)min,(197±34)min；F=3.22,P =0.04].全组住院死亡13例(8.1％)；主动脉根部置换组5例(6.9％),主动根部重建组7例(8.8％),David术组1例.死亡原因:呼吸功能衰竭4例,永久性神经功能障碍3例,多脏器功能不全4例,急性肾功能衰竭2例.生存者术后随访6个月至6年,无因主动脉根部病变而再行手术治疗者.主动脉根部重建组与David手术组术后效果差异无统计学意义(P＞0.05).结论 Stanford A型主动脉夹层导致主动脉根部病变,根据病变情况选择合理的手术方式,可取得较满意的疗效.
목적 탐토Stanford A형주동맥협층근부처리적방법급료효평개.방법 회고성분석2001년1월지2011년6월접수치료적161례Stanford A형주동맥협층환자적림상자료.남성122례,녀성39례；평균년령(44±21)세.급성주동맥협층146례,만성주동맥협층15례.주동맥근부균유불동정도적병변,기중좌관상동맥-무관상동맥화(혹)우관상동맥-무관상동맥교계시탈140례,주동맥판중도이상반류75례,주동맥두부내막파구15례,좌혹우관상동맥시탈8례,좌혹우관상동맥협층16례,합병주동맥근부류31례.결과 본조환자행주동맥근부치환(Bentall술)72례,주동맥근부중건(포괄주동맥판치환술)80례,David수술9례.주동맥근부중건조심폐전류시간소우주동맥근부치환조급David수술조[(193±42) min,(210 ±61)min,(197±34)min；F=3.22,P =0.04].전조주원사망13례(8.1％)；주동맥근부치환조5례(6.9％),주동근부중건조7례(8.8％),David술조1례.사망원인:호흡공능쇠갈4례,영구성신경공능장애3례,다장기공능불전4례,급성신공능쇠갈2례.생존자술후수방6개월지6년,무인주동맥근부병변이재행수술치료자.주동맥근부중건조여David수술조술후효과차이무통계학의의(P＞0.05).결론 Stanford A형주동맥협층도치주동맥근부병변,근거병변정황선택합리적수술방식,가취득교만의적료효.
Objective To investigate the effectiveness of surgical approaches,outcomes and prognosis of aortic root pathology due to Stanford A aortic dissection.Methods Retrospective analysis the clinical data of 161 patients (122 male and 39 female,mean age of (44 ± 21) years) underwent surgical treatment for Stanford A aortic dissection between January 2001 and June 2011.There were 146 patients of acute aortic dissection and 15 patients of chronic aortic dissection.All the patients had aortic root pathologies that included commissural prolapsed in 140 cases,more than moderate aortic insufficiency in 75 cases,aortic sinus intima rupture in 15 cases,right and/or left coronary artery tearing in 8 cases,right and/or left coronary artery dissection in 16 cases,aortic root aneurysm in 31 cases.Results Aortic root replacement (Bentall procedures) were used in 72 cases,aortic root remodeling (including aortic valve replacement) in 80 cases,aortic root reimplantation (David procedure) in 9 cases.The cardiopulmonary bypass time was shorter in aortic root remodeling group ((193 ± 42) minutes) than the other two groups ((210 ± 61)minutes,(197 ± 34) minutes,F =3.22,P =0.04).The in-hospital mortality was 8.1％ (13 cases),5 cases(6.9％) in aortic root replacement group,7 cases(8.8％) in aortic root remodeling group,1 case in aortic root reimplantation.The cause of death included respiratory failure (4 cases),permanent neurological deficits (3 cases),multiple organ failure (4 cases),acute renal failure (2 cases).The survivors were followed up for 6 months to 6 years.There was no patient required reoperation for aortic root pathologies.There was no statistically significant difference between aortic root remodeling group and reimplantation group (P ＞ 0.05).Conclusions The surgical treatment for aortic root pathology due to Stanford A aortic dissection is challenging.Appropriate procedures according to the specialty of aortic root pathology can be performed with favorable functional results.