CAJ | 학술논문

目的探讨原发破口位于降主动脉、假腔逆行剥离累及升主动脉的Stanford A型主动脉夹层的手术疗效及近期随访结果.方法 2009年2月至2012年11月,急性逆剥Stanford A型主动脉夹层患者69例,男60例,女9例;年龄22～ 67岁,平均(46±9)岁,均采用全弓替换+支架象鼻术(孙氏手术)治疗.根部处理采用Bentall手术8例、主动脉瓣交界悬吊+升主动脉替换术32例、部分窦部成形+升主动脉替换术7例、升主动脉替换术22例.术前并发急性肾损伤11例、下肢缺血9例、心包积液和脑卒中各3例.通过CTA对术后残余假腔进行随访评价.结果住院死亡4例,持续机械通气＞1周2例,肾功能不全6例(5例行连续性肾替代治疗).二次开胸1例,1例因迷走右锁骨下动脉窃血行腔内栓堵术.术后3个月假腔血栓化率,降主动脉起始水平63例(96.9％),膈肌水平45例(69.2％).65例生存患者随访(28±12)个月.再手术2例,1例支架型人工血管远端新发破口行腔内修复,1例降主动脉瘤样扩张行胸腹主动脉替换.术后无截瘫、脑卒中、主动脉破裂等严重并发症发生.结论孙氏手术治疗破口位于降主动脉的急性A型逆行剥离夹层有效,近期随访效果良好.
목적 탐토원발파구위우강주동맥、가강역행박리루급승주동맥적Stanford A형주동맥협층적수술료효급근기수방결과.방법 2009년2월지2012년11월,급성역박Stanford A형주동맥협층환자69례,남60례,녀9례;년령22～ 67세,평균(46±9)세,균채용전궁체환+지가상비술(손씨수술)치료.근부처리채용Bentall수술8례、주동맥판교계현조+승주동맥체환술32례、부분두부성형+승주동맥체환술7례、승주동맥체환술22례.술전병발급성신손상11례、하지결혈9례、심포적액화뇌졸중각3례.통과CTA대술후잔여가강진행수방평개.결과 주원사망4례,지속궤계통기＞1주2례,신공능불전6례(5례행련속성신체대치료).이차개흉1례,1례인미주우쇄골하동맥절혈행강내전도술.술후3개월가강혈전화솔,강주동맥기시수평63례(96.9％),격기수평45례(69.2％).65례생존환자수방(28±12)개월.재수술2례,1례지가형인공혈관원단신발파구행강내수복,1례강주동맥류양확장행흉복주동맥체환.술후무절탄、뇌졸중、주동맥파렬등엄중병발증발생.결론 손씨수술치료파구위우강주동맥적급성A형역행박리협층유효,근기수방효과량호.
Objective To explore the surgical treatment strategy and short-term follow-up effect in Sun's procedure on the acute Stanford type A aortic dissection,the primary tears were located in the descending aorta,false lumen inversely extended involvement of the ascending aorta.Methods A retrospective analysis the clinical data of 69 consecutive cases with acute retrograde type A aortic disscction treated by surgical strategies,total arch replace with stent elephant technical (Sun's surgery),in Anzhen hospital from February 2009 to November 2012.Male 60 cases,female 9 cases,aged 22-67 years (46 ±9 years).Root operation strategies:Bentall procedure 8 cases,aortic valve commission suspension and ascending aorta replacement 32 cases,partial valsalva sinus plasty and ascending aorta replacement 7 cases,ascending aorta replacement 22 cases.Preoperative complications included pericardial effusion in 3 case,stroke in 3 case,acute kidney injury in 11 cases,9 cases of lower limb ischemia.CTA was used to evaluate postoperative residual false lumen.Results Inhospital dies 4 cases,continuous mechanical ventilation ＞ 1 week in 2 cases,6 cases of renal insufficiency (of which 5 cases were performed routine C RRT).Secondary thoracotomy in 1 case,1 case with vagus right subclavian artery was performed endovascular aortic repair.False lumen thrombosis rate 3 months after operation starting level of descending aorta 63 cases(96.9％),diaphragm level 45 cases (69.2％).Follow-up of 65 cases,5 cases were lost to follow-up,and the follow-up rate was 92.3％ with an average follow-up time 28(28 ± 12) months.Reoperation in 2 cases,of which 1 case was performed endovascular repair to close new entry at stent artificial vascular distal, 1 case was performed chest aorta replacement as descending aortic aneurysm.No paraplegia, serious complications such as stroke, aortic rupture occurred.Conclusion Sun' s procedure was effective on the acute Stanford type A aortic dissection, in which the primary tears were located in the descending aorta and false lumen inverse extended involvement of the ascending aorta, and short-term follow-up effect was excellent.