CAJ | 학술논문

目的总结全弓置换术治疗老年DeBakey Ⅰ型主动脉夹层的临床经验和疗效. 方法 2008年1月至2013年1月,51例年龄≥60岁老年Ⅰ型主动脉夹层患者在深低温停循环、双侧顺行脑灌注下行全弓置换术,降主动脉行硬象鼻并开窗重建左锁骨下动脉,主动脉根部采取David术23例,Bentall手术14例;Wheat术4例,单纯升主动脉置换10例,四分支人工血管重建弓部及另外两个分支动脉. 结果 51例患者死亡4例,1例因心脏无法复跳手术死亡,术后死亡3例.平均体外循环(208.7±36.5)min,心肌阻断(93.5±14.3)min,停循环(40.5±9.5)min.急性肾衰竭行床旁透析4例,气管切开3例,脑梗死1例,3例短暂性脑神经功能异常.47例患者术后复查主动脉CT血管造影术(CTA)示人工血管通畅、无内漏,支架远端降主动脉假腔闭合38例.随访6～57个月后复查CTA 45例,胸降主动脉夹层假腔闭合40例,无再次手术. 结论全弓置换术治疗老年Ⅰ型主动脉夹层安全有效,合理的术中处理方式是手术成功的关键.
목적 총결전궁치환술치료노년DeBakey Ⅰ형주동맥협층적림상경험화료효. 방법 2008년1월지2013년1월,51례년령≥60세노년Ⅰ형주동맥협층환자재심저온정순배、쌍측순행뇌관주하행전궁치환술,강주동맥행경상비병개창중건좌쇄골하동맥,주동맥근부채취David술23례,Bentall수술14례;Wheat술4례,단순승주동맥치환10례,사분지인공혈관중건궁부급령외량개분지동맥. 결과 51례환자사망4례,1례인심장무법복도수술사망,술후사망3례.평균체외순배(208.7±36.5)min,심기조단(93.5±14.3)min,정순배(40.5±9.5)min.급성신쇠갈행상방투석4례,기관절개3례,뇌경사1례,3례단잠성뇌신경공능이상.47례환자술후복사주동맥CT혈관조영술(CTA)시인공혈관통창、무내루,지가원단강주동맥가강폐합38례.수방6～57개월후복사CTA 45례,흉강주동맥협층가강폐합40례,무재차수술. 결론 전궁치환술치료노년Ⅰ형주동맥협층안전유효,합리적술중처리방식시수술성공적관건.
Objective To review the clinical experience and efficacy of total aortic arch replacement for elderly patients with DeBakey Ⅰ aortic dissection.Methods From January 2008 to January 2013,a total of 51 patients aged over 60 years with type Ⅰ aortic dissection underwent total arch replacement surgery in deep hypothermic circulatory arrest with bilateral antegrade cerebral perfusion.The descending aorta was treated by stent elephant trunk technique and fenestration on the trunk to reconstructing the left subclavian artery.The aortic root underwent David surgery in 23 cases,Bentall in 14 cases,Wheat in 4 cases,and simple replacement of ascending aorta in 10 cases.Aortic arch and other two branch arteries were rebuilt by 4-branched artificial vascular graft.Results In 51 patients,4 cases died,in which 1 case died due to inability of the heart resuscitation in operation,and postoperative death occurred in 3 patients.The mean cardiopulmonary bypass time were (208.7±36.5) min,heart interruption time were (93.5± 14.3) min,and circulatory arrest time were (40.5± 9.5) min.Patients with acute renal failure were treated by bedside hemodialysis in 4 cases and tracheotomy in 3 cases.There were 1 case with cerebral infarction and 3 cases with transient neurological abnormalities.Postoperative aortic CT angiography in 47 cases showed that artificial vascular patency and no inner leakage in all patients,and the distal false lumen of stent in the descending aorta was closed in 38 cases.Patients were followed up for 6 to 57 months,and postoperative aortic CT angiography in showed that 40 cases with false lumen in descending thoracic aortic dissection were closed in 47 cases.No re-operation in all patients.Conclusions Total arch replacement surgery for senile patients with type Ⅰ aortic dissection is safe and effective.The reasonable operation treatment is the key to successful operation.