中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2014年
6期
436-441
,共6页
申运华%严中亚%严光%卢中%程光存%王晓玲%朱正艳%雷虹%吴一军
申運華%嚴中亞%嚴光%盧中%程光存%王曉玲%硃正豔%雷虹%吳一軍
신운화%엄중아%엄광%로중%정광존%왕효령%주정염%뢰홍%오일군
动脉瘤,夹层%主动脉疾病%支架%治疗结果
動脈瘤,夾層%主動脈疾病%支架%治療結果
동맥류,협층%주동맥질병%지가%치료결과
Aneurysm,dissecting%Aortic diseases%Stents%Treatment outcome
目的 探讨个体化组合式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加支架“象鼻”手术进行比较.方法 回顾性分析2007年1月至2013年7月接受手术治疗的Stanford A型主动脉夹层患者的临床资料,筛选出接受全弓置换加支架“象鼻”手术及个体化组合式分支覆膜支架重建主动脉弓的患者共44例,男性29例,女性15例,年龄25～59岁,平均年龄(42±9)岁.其中行全弓置换+象鼻支架置入术22例(全弓置换组);行个体化组合式分支覆膜支架重建主动脉弓部手术22例(个体化组).两组患者的年龄、性别和病情差异无统计学意义(P＞0.05).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 患者手术全部成功,无死亡病例.全弓置换组的心肺转流时间、心肌阻断时间、停循环或选择性脑灌注时间、术后胸腔引流量、术后呼吸机辅助呼吸时间、输血量均高于个体化组(f=2.791～43.465,均P＜0.05).术后1个月,全弓置换组和个体化组胸主动脉最大内径均小于术前[(33 ±1)mm比(45 ±6) mm(t=10.076,P=0.000),(33 ±2)mm比(45 ±8)mm(t =5.979,P=0.000)];两组射血分数与术前比较差异无统计学意义(P＞0.05).结论 个体化组合式分支覆膜支架重建主动脉弓部手术和全弓置换加支架“象鼻”手术治疗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、术后胸腔引流量.
目的 探討箇體化組閤式分支覆膜支架重建主動脈弓部手術治療Stanford A型主動脈夾層的療效,併與傳統的全弓置換加支架“象鼻”手術進行比較.方法 迴顧性分析2007年1月至2013年7月接受手術治療的Stanford A型主動脈夾層患者的臨床資料,篩選齣接受全弓置換加支架“象鼻”手術及箇體化組閤式分支覆膜支架重建主動脈弓的患者共44例,男性29例,女性15例,年齡25～59歲,平均年齡(42±9)歲.其中行全弓置換+象鼻支架置入術22例(全弓置換組);行箇體化組閤式分支覆膜支架重建主動脈弓部手術22例(箇體化組).兩組患者的年齡、性彆和病情差異無統計學意義(P＞0.05).術前均行超聲心動圖、主動脈CT血管造影檢查.術後1箇月進行臨床隨訪和超聲心動圖、主動脈CT血管造影複查.結果 患者手術全部成功,無死亡病例.全弓置換組的心肺轉流時間、心肌阻斷時間、停循環或選擇性腦灌註時間、術後胸腔引流量、術後呼吸機輔助呼吸時間、輸血量均高于箇體化組(f=2.791～43.465,均P＜0.05).術後1箇月,全弓置換組和箇體化組胸主動脈最大內徑均小于術前[(33 ±1)mm比(45 ±6) mm(t=10.076,P=0.000),(33 ±2)mm比(45 ±8)mm(t =5.979,P=0.000)];兩組射血分數與術前比較差異無統計學意義(P＞0.05).結論 箇體化組閤式分支覆膜支架重建主動脈弓部手術和全弓置換加支架“象鼻”手術治療Stanford A型主動脈夾層均有良好的近期臨床療效,前者簡化瞭手術步驟,縮短瞭手術時間,減少瞭輸血量、術後胸腔引流量.
목적 탐토개체화조합식분지복막지가중건주동맥궁부수술치료Stanford A형주동맥협층적료효,병여전통적전궁치환가지가“상비”수술진행비교.방법 회고성분석2007년1월지2013년7월접수수술치료적Stanford A형주동맥협층환자적림상자료,사선출접수전궁치환가지가“상비”수술급개체화조합식분지복막지가중건주동맥궁적환자공44례,남성29례,녀성15례,년령25～59세,평균년령(42±9)세.기중행전궁치환+상비지가치입술22례(전궁치환조);행개체화조합식분지복막지가중건주동맥궁부수술22례(개체화조).량조환자적년령、성별화병정차이무통계학의의(P＞0.05).술전균행초성심동도、주동맥CT혈관조영검사.술후1개월진행림상수방화초성심동도、주동맥CT혈관조영복사.결과 환자수술전부성공,무사망병례.전궁치환조적심폐전류시간、심기조단시간、정순배혹선택성뇌관주시간、술후흉강인류량、술후호흡궤보조호흡시간、수혈량균고우개체화조(f=2.791～43.465,균P＜0.05).술후1개월,전궁치환조화개체화조흉주동맥최대내경균소우술전[(33 ±1)mm비(45 ±6) mm(t=10.076,P=0.000),(33 ±2)mm비(45 ±8)mm(t =5.979,P=0.000)];량조사혈분수여술전비교차이무통계학의의(P＞0.05).결론 개체화조합식분지복막지가중건주동맥궁부수술화전궁치환가지가“상비”수술치료Stanford A형주동맥협층균유량호적근기림상료효,전자간화료수술보취,축단료수술시간,감소료수혈량、술후흉강인류량.
Objective To compare the clinical efficacy between total aortic arch reconstruction with a individualized combined branched stent grafting technique and total aortic arch replacement combined with stented elephant trunk implantation for patients with Stanford A aortic dissection.Methods Totally 44 patients with Stanford A aortic dissection treated with surgical treatment from January 2007 to July 2013 were included in this study.The patients were divided into two groups.Group A(n =22)patients were treated by total arch replacement with stented elephant trunk procedure.Group B (n =22) patients received individualized combined branched stent grafting technique.Age,gender and disease severity were similar between the two groups (all P ＞ 0.05).Echocardiography and aortic CT angiography were performed preoperation and at 1 month after operation.Results Operation was successful in all 44 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 A patients compared those in group B patients (t =2.791 to 43.465,all P ＜0.05).One month after operation,the maximum internal diameter of aorta was smaller than pre-operation in both group A ((33 ± 1) mm vs.(45 ± 6) mm,t =10.076,P=0.000) and group B ((33 ±2) mm vs.(45 ±8) mm,t =5.979,P =0.000).Left ventricular ejection fraction had no significant difference before and 1 month after operation in both groups (P ＞ 0.05).Conclusion The total aortic arch reconstruction with individualized combined branched stent grafting technique is technically easier,shortens the operation time,reduces the blood transfusion volume compared to the classical aortic arch operation.
