CAJ | 학술논문

目的：评价三分支主动脉弓覆膜支架与传统手术对急性A型主动脉夹层主动脉弓重建的早期临床效果。方法2008年6月至2014年1月，39例A型主动脉夹层患者按手术方式分成2组。 A组：术中直视下三分支主动脉弓覆膜支架置入18例。男13例，女5例，年龄33～57（43．46±6．23）岁。同期升主动脉行单纯置换15例，主动脉根部置换3例。 B组：实施传统全弓替换＋象鼻支架21例，男16例，女5例，年龄39～59（45．23±7．10）岁。同期升主动脉单纯置换8例，主动脉根部置换10例，主动脉瓣成形3例，冠状动脉旁路移植术3例。结果 A组：术后二次开胸止血3例，脑卒中2例，术后院内死亡4例，其中肾功能衰竭2例治疗无效后死亡，移植物及胸骨感染各死亡1例。存活14例患者平均随访（34．26±16．12）个月，随访率100％，随访期间无死亡，支架血管段假腔血栓化占77．5％。 B组：术后二次开胸止血2例，脑卒中1例，术后院内死亡3例，其中心功能衰竭2例治疗无效后死亡，下肢缺血坏死导致感染死亡1例。存活18例患者平均随访（35．19±17．20）个月，随访率100％，随访期间无死亡，支架血管段假腔血栓化占98．7％。结论应用三分支主动脉弓覆膜支架治疗主动脉夹层取得同样良好的早期临床效果，但其手术适应症窄，选择时要更慎重。相对于传统支架血管象鼻术，其假腔血栓化率低。
목적：평개삼분지주동맥궁복막지가여전통수술대급성A형주동맥협층주동맥궁중건적조기림상효과。방법2008년6월지2014년1월，39례A형주동맥협층환자안수술방식분성2조。 A조：술중직시하삼분지주동맥궁복막지가치입18례。남13례，녀5례，년령33～57（43．46±6．23）세。동기승주동맥행단순치환15례，주동맥근부치환3례。 B조：실시전통전궁체환＋상비지가21례，남16례，녀5례，년령39～59（45．23±7．10）세。동기승주동맥단순치환8례，주동맥근부치환10례，주동맥판성형3례，관상동맥방로이식술3례。결과 A조：술후이차개흉지혈3례，뇌졸중2례，술후원내사망4례，기중신공능쇠갈2례치료무효후사망，이식물급흉골감염각사망1례。존활14례환자평균수방（34．26±16．12）개월，수방솔100％，수방기간무사망，지가혈관단가강혈전화점77．5％。 B조：술후이차개흉지혈2례，뇌졸중1례，술후원내사망3례，기중심공능쇠갈2례치료무효후사망，하지결혈배사도치감염사망1례。존활18례환자평균수방（35．19±17．20）개월，수방솔100％，수방기간무사망，지가혈관단가강혈전화점98．7％。결론응용삼분지주동맥궁복막지가치료주동맥협층취득동양량호적조기림상효과，단기수술괄응증착，선택시요경신중。상대우전통지가혈관상비술，기가강혈전화솔저。
[ Abstract]:Objective To evaluate results of surgical treatment for patients with acute type A aortic dissection using triple-branched stent graft and traditional operation. Methods From June 2008 to January 2014, total 39 patients with type A aortic dissec?tion were divided into two groups according to different operation procedure. In A group, 18 patients, including 13 males and 5 females underwent surgical treatment using triple-branched stent graft. In B group, 21 patients, including 16 males and 5 females with the mean age of 45.23±7.10 (35-59) years old, underwent surgical treatment using traditional arch replacement procedure. Results In A group, there were 3 cases (16.7%) of postoperative bleeding and 4 cases (22.2%) of in-hospital deaths. The causes of death included acute renal failure (2 cases), graft infection (1 case) and sternal infection (1 case). During a mean follow-up of 34.26 ±16.12 months, there was no late death. The false lumen thrombosis between the stent graft and the aortic lumen was observed in 12 patients (85.7%, 12/14). While in B group, postoperative bleeding was observed in 2 patients (9.5%), and 2 patients died due to heart failure and 1 died due to severe inferior limb infection. During a mean follow-up of 35.19 ±17.20 months, there was no late death. The false lumen thrombosis between the stent graft and the aortic lumen was 98.7%. Conclusion Under strict indication criteria, it is feasible to perform triple-branched stent graft proce?dure in patients with acute aortic dissection ( type A) , which can simplify operative procedure for the arch. But campared with the fro?zen elephant trunk technique, the rate of false lumen thrombosis is lower using this procedure.