摘要
目的 总结应用孙氏手术治疗TEVAR术后B型夹层逆剥的经验及早、中期效果.方法 2009年4月至2013年4月,14例B型主动脉夹层腔内血管修复（EVAR）术后夹层逆行剥离患者,年龄31～65岁,平均（44.1±8.8）岁,均采用孙氏手术治疗.术后定期随访CTA观察主动脉情况和患者术后并发症（心脑血管、截瘫和死亡等事件）发生率.结果 体外循环（188.6±25.7） min,选择性脑灌注（26.0±9.4） min.术后1例死于感染、多脏器功能衰竭.无截瘫及卒中.13例随访12～33个月,平均（18.3±6.1）个月.随访期内1例由于残存降主动脉假腔扩张再手术治疗,术后生存良好.结论 应用孙氏手术治疗B型主动脉夹层EVAR术后夹层逆行剥离,术后早期效果较好,中期随访结果良好.
Objective To evaluate the feasibility of Sun＇s procedure（total arch replacement with stented elephant trunk procedure） for acute retrograde extension of type B aortic dissection following endovascular aortic repair（EVAR）.Methods Between April 2009 and April 2013,a total of 14 patients suffered acute retrograde aortic dissection after EVAR for type B aortic dissections.The mean age at operation was （44.1 ± 8.8） years （range,31-65 years）.The surgeries were performed by using Sun＇s procedure.Complications such as neurological,renal and respiratory morbidity were recorded to evaluate the immediate and mid-term results.Computed tomographic angiogram（CTA） was performed before discharge as well as 3,6 months after,and thereafter annually to evaluate the postoperative condition of the aorta.Results CPB time was （188.6 ± 25.7） min,selected cerebral perfusion time was （26.0 ± 9.4） min.The procedure was successful in all patients but one patient died of infection and multiple organ failure after the operation.No patient suffered paraplegia or stroke after operation.Follow-up was completed with 13 survivors.The mean follow-up period was（18.3 ± 6.1） months（range,12-33 months）.During follow-up CTA-scans thrombus formation was observed within the descending aortic false lumen excluded by the stented graft.No late death was observed during follow-up.One patient underwent reoperation for replacement of the remaining descending aorta and enjoyed uneventful survival.Conclusion Sun＇s procedure could be a recommendable option for retrograde dissection with acceptable surgical risks and satisfactory results.
出处
《中华胸心血管外科杂志》
CSCD
2015年第3期168-170,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
北京市科学技术委员会—国际科技合作与交流专项（2012DFA31110）
北京市卫生系统高层次卫生技术人才培养计划—领军人才（2011-1-3）
关键词
主动脉
动脉瘤
夹层
心脏外科手术
腔内血管修复术
孙氏手术
Aorta
Aneurysm, dissection
Cardiac surgical proecdures
Endovascular aortic repair
Sun＇s procedure
