摘要
目的探讨三分支覆膜支架重建主动脉弓部手术治疗StanfordA型主动脉夹层的疗效，并与传统的全弓置换±象鼻支架置入术进行疗效的比较。方法自2006年1月至2011年5月，对28例StanfordA型主动脉夹层患者行手术治疗，其中20例患者以全弓置换＋象鼻支架置入术治疗（I组），8例患者以三分支覆膜支架重建主动脉弓部手术治疗（Ⅱ组）。术前均行超声心动图、主动脉CT血管造影检查。术后1个月进行临床随访和超声心动图、主动脉CT血管造影复查。结果两组患者的年龄、性别和病情差异无统计学意义（P均〉0．05）。患者手术全部成功，无死亡病例。I组的体外循环时间、心肌阻断时间、停循环或选择性脑灌注时间、术后引流量、术后呼吸机辅助呼吸时间、输血量和住院费用均多于Ⅱ组（P均〈0．05）。术后1个月，Ⅰ组胸主动脉最大内径小于术前[（30．2±3．I）mm比（42．5±6．5）mm，P〈0．05]，Ⅱ组胸主动脉最大内径也小于术前[（31．5±2．5）mmtL（44．1±7．3）mm，P〈0．05]；两组患者左心室射血分数与术前比较差异均无统计学意义（P均〉0．05）。结论三分支覆膜支架重建主动脉弓部手术和全弓置换＋象鼻支架置入术治疗StanfordA型主动脉夹层均有良好的近期临床疗效，前者简化了手术步骤，缩短了手术时间，减少了输血量、术后引流量及住院费用。
Objective To compare the clinical efficacy between total aortic arch reconstruction with open triple-branched stent graft placement and total aortic replacement combined with stented elephant trunk implantation for patients with Stanford A aortic dissection. Methods Patients with Stanford A aortic dissection treated with surgical treatment from January 2006 to May 2011 were included in this study. The patients were divided into two groups. Group I （ n = 20） patients were treated by total arch replacement with stented elephant trunk procedure. Group Ⅱ （ n = 8 ） patients received open triple-branched stent graft placement. Echocardiography and aortic CT angiography were performed before and at 1 month after operation. Results Age, gender and disease severity were similar between the 2 groups （ all P 〉 0. 05 ）. Operation was successful in all 28 patients. Cardiopulmonary bypass time, aortic cross clamp time, circulation arrest time and duration of ventilator assisted breathing were significantly longer; postoperative drainage volume and blood transfusion volume were significantly larger and hospitalization cost was significantly higher in group I patients compared those in group Ⅱ patients （ all P 〈 0. 05 ）. One month after operation, the maximum internal diameter of aorta was smaller than pre-operation in both group Ⅰ （ 30. 2 ± 3.1 ） mm vs. （42.5 ±6.5） mm, P 〈0.05] and group 1/ E（31.5 ±2.5） mm vs. （44.1 ±7.3） mm, P 〈0.05]. Conclusions Short-term procedural success rate was similar between the two groups. The total aortic arch reconstruction with open triple-branched stent graft placement procedure is simpler, shortens the operation time ,reduces the blood transfusion volume and is more cost-effective compared to the classical aortic arch operation.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第8期676-680,共5页
Chinese Journal of Cardiology
关键词
主动脉疾病
支架
治疗结果
Aortic diseases
Stents
Treatment outcome
