摘要
目的总结升主动脉疾病的外科手术治疗经验。方法升主动脉瘤患者25例(累及部分弓部或者全弓4例),急性Stanford A型主动脉夹层13例,均在全麻低温体外循环下经前正中切口手术。其中Bentall手术17例,Wheat手术1例,升主动脉替换手术3例,升主动脉替换加右半弓或者全弓替换手术4例,升主动脉及全弓替换加支架"象鼻"手术("孙氏"手术)4例,Bentall加新型三分支主动脉弓覆膜支架置入手术2例,主动脉瓣成形及升主动脉替换加新型三分支主动脉弓覆膜支架置入手术7例;同期行二尖瓣成形术1例,二尖瓣机械瓣替换术1例。结果全组平均体外循环时间(128.4±30.5)min,平均心肌血运阻断时间(80.3±14.7)min;17例行深低温停循环选择性脑灌注时间10～22 min,平均(17.5±8.3)min。呼吸机辅助时间(46.1±20.9)h,ICU停留时间(92.5±37.1)h,术后住院时间(13.7±7.4)d。死亡2例(5.3%),1例死于术中大出血,1例死于术后重症肺部感染。术后24小时内心包和纵隔引流量(448.6±262.5)ml,无二次开胸止血者。术后5例出现低氧血症,3例并发精神症状,1例出现伤口感染,均治愈。36例随访1个月至11年,均生存,心功能恢复至Ⅰ～Ⅱ级,生活质量良好。结论 选择最佳的手术方式是外科治疗升主动脉疾病的关键。Bentall手术是治疗升主动脉瘤的主要术式,"孙氏"手术则是治疗Stanford A型主动脉夹层的经典术式;应用新型三分支主动脉弓覆膜支架重建主动脉弓部,可以简化弓部操作,降低手术风险,提高手术成功率,适用于大部分急性Stanford A型主动脉夹层患者。
Objective To summarize the experience of surgical treatment for ascending aortic disease.Methods Thirty-eight patients with ascending aortic disease included 25 patients with ascending aortic aneurysm（part aortic arch or total aortic arch involved in 4 patients） and 13 patients with acute Stanford type A aortic dissection.All patients underwent surgical treatment with hypothermic extracorporeal circulation by anterior median incision,including Bentall procedure in 17 patients,Wheat procedure in 1 patient,ascending aorta replacement in 3 patients,ascending aorta replacement and right hemi-aortic arch or total aortic arch replacement in 4 patients,ascending aorta replacement and total aortic arch replacement with elephant trunk implantation（Sun＇s procedure） in 4 patients,Bentall procedure and new triple-branched aortic arch covered stent graft placement in 2 patients,aortic valvuloplasty and ascending aorta replacement and new triple-branched aortic arch covered stent graft placement in 7 patients.Concomitant procedures included 1 case of mitral valvuloplasty and 1 case of mitral valve replacement.Results The average extracorporeal circulation time was（128.4±30.5）minutes.The clamp time was（80.3±14.7）minutes.The deep hyperthermic circulatory arrest and antegrade selective cerebral perfusion time was（17.5±8.3）minutes（from 10 to 22 minutes） in 17 patients.The mechanical ventilation time was（46.1±20.9）hours.The ICU stay was（92.5±37.1）hours.And the postoperative hospital stay was（13.7±7.4）days.Two patients died of intra-operative heavy bleeding and postoperative severe pulmonary infection respectively.The quantity of postoperative first 24 hours drainage was（448.6±262.5）milliliters.And no patient underwent reoperation for bleeding.Five patients complicated with hypoxemia,3 patients with mental symptom,and 1 patient with incision infection were cured and discharged.During following-up period of 1 month to 11 years,36 patients survived and had a high quality life with impro
出处
《实用医院临床杂志》
2011年第5期26-28,共3页
Practical Journal of Clinical Medicine
