CAJ | 학술논문

目的总结孙氏手术治疗复杂主动脉夹层的初步效果和临床经验.方法 2009年2月至2011年12月,393例复杂的主动脉夹层患者在北京市大血管中心接受孙氏手术,其中A型夹层377例,B型夹层16例；急性期222例,慢性期171例.男314例,女79例；年龄19～75岁,平均(46.6±11.0)岁.主要合并症为高血压261例,主动脉瓣关闭不全120例,主动脉根部瘤59例,马方综合征32例,冠心病25例.既往有心血管手术史39例,胸主动脉覆膜支架置入史12例.并对心血管手术后需再次外科干预的相关危险因素进行logistic回归分析.结果 393例孙氏手术中头臂血管行岛状吻合51例,象鼻支架中有8例采用了单分支支架.急诊手术222例(56.5％,222/393).同期合并手术主要包括Bentall手术137例,升主动脉替换127例,主动脉瓣成形61例,冠状动脉旁路移植术28例.体外循环(194.4±52.7)min,低流量选择性脑灌(23.1±7.4)min.住院死亡13例(3.3％,13/393),30天死亡25例(6.4％,25/393),主要死因为术后多脏器功能衰竭、循环衰竭等.并发症57例,发生率(14.5％,57/393),主要包括多脏器功能衰竭、神经系统并发症、出血、肾功能不全或衰竭等.39例既往有心血管手术病史的患者的logistic回归分析结果显示,马方综合征是心血管手术后需要再次外科干预的危险因素.结论孙氏手术治疗复杂型主动脉夹层有效,并可以获得满意的早期临床效果,而马方综合征患者术后多需要再次外科干预.中、远期结果需进一步随访.
목적 총결손씨수술치료복잡주동맥협층적초보효과화림상경험.방법 2009년2월지2011년12월,393례복잡적주동맥협층환자재북경시대혈관중심접수손씨수술,기중A형협층377례,B형협층16례；급성기222례,만성기171례.남314례,녀79례；년령19～75세,평균(46.6±11.0)세.주요합병증위고혈압261례,주동맥판관폐불전120례,주동맥근부류59례,마방종합정32례,관심병25례.기왕유심혈관수술사39례,흉주동맥복막지가치입사12례.병대심혈관수술후수재차외과간예적상관위험인소진행logistic회귀분석.결과 393례손씨수술중두비혈관행도상문합51례,상비지가중유8례채용료단분지지가.급진수술222례(56.5％,222/393).동기합병수술주요포괄Bentall수술137례,승주동맥체환127례,주동맥판성형61례,관상동맥방로이식술28례.체외순배(194.4±52.7)min,저류량선택성뇌관(23.1±7.4)min.주원사망13례(3.3％,13/393),30천사망25례(6.4％,25/393),주요사인위술후다장기공능쇠갈、순배쇠갈등.병발증57례,발생솔(14.5％,57/393),주요포괄다장기공능쇠갈、신경계통병발증、출혈、신공능불전혹쇠갈등.39례기왕유심혈관수술병사적환자적logistic회귀분석결과현시,마방종합정시심혈관수술후수요재차외과간예적위험인소.결론 손씨수술치료복잡형주동맥협층유효,병가이획득만의적조기림상효과,이마방종합정환자술후다수요재차외과간예.중、원기결과수진일보수방.
Objective To summarize our clinical experiences and results of Sun's procedure in the management of complicated aortic dissection.Methods From February 2009 to December 2011,393 patients (314 males and 79 females) of complicated aortic dissection underwent Sun's procedure in Beijing aortic disease center.Stanford type A aortic dissection occurred in 377 cases and type B was 16 cases.222 cases were operated in acute phase and 171cases in chronic phase.The mean age was (46.6 ± 11.0) years.Associated with hypertension in 261 cases,Marfan syndrome in 32 cases,aortic root aneurysm in 59 cases,aortic valve insufficiency in 120 cases,coronary artery disease in 25 cases.Previous history of cardiovascular surgery in 39 cases and thoracic endovascular aneurysm repair in 12 cases.The risk factors of reoperation were analyzed with Logistic regression analysis.Results Sun's procedure was operated on 393 cases,enblock anastomosis of the brachiocephalic vessels in 51 cases,single branch stent was used in 8 patients.Emergency operation rate was 56.5％ (222/393).Concomitant procedures included Bentall in 137 cases,replacement of the ascending aorta in 127 cases,Aortic valvuloplasty in 61 cases,CABG in 28 cases.The times of cardiopulmonary bypass and selective cerebral perfusion averaged (194.4 ± 52.7) minutes and (23.1 ± 7.4) minutes,respectively.The in-hospital mortality was 3.3 ％ (13/393) and thirty-day mortality was 6.4％ (25/393),mainly caused by postoperative multiple organ failure and circulation failure.Complications occurred in 57 cases (14.5％,57/393),including multiple organ failure,neurological complications,bleeding,renal insufficiency or failure.Logistic regression analysis was analyzed in 39 patients with a history of previous cardiovascular surgery,the results shows that Marfan syndrome is the risk factor of surgical intervention after cardiovascular surgery.Conclusion Sun's procedure of complicated aortic dissection is an effective treatment and can achieve satisfactory clinical results and Marfan syndrome is the risk factor of surgical intervention after cardiovascular surgery.The mid-and long-term results need the further follow-up.