摘要
目的应用改良全弓置换技术治疗Stanford A型主动脉夹层,通过评估其临床疗效来评价该技术的安全性及有效性。方法 2015年6月至2016年12月对连续39例Stanford A型主动脉夹层患者行改良全弓置换术,所有患者均在全身麻醉、浅低温停循环及双侧顺行性脑灌注下进行。根据主动脉根部病变情况采取相应术式:行Bentall术4例,David术2例,主动脉瓣成形+升主动脉置换术25例,Cabrol术8例;弓部处理均采用改良全弓置换+支架象鼻术;同期行二尖瓣成形术1例,三尖瓣成形术1例。结果全组体外循环时间(218.5±42.2)min,主动脉阻断时间(134.2±32.4)min,停循环时间(4.9±2.3)min,手术时间(415.5±80.5)min,术后透析4例,短暂性神经并发症2例,无永久性神经系统并发症,术后无截瘫,住院期间无死亡。全组患者出院前及出院后3个月复查心脏彩超及主动脉全程CT。降主动脉假腔完全性血栓化37例,部分性血栓化2例。结论改良全弓置换技术治疗Stanford A型主动脉夹层是安全、有效的,可降低术后并发症发生率,近期疗效满意。
Objective To evaluate the safety and effectiveness of modified total arch replacement by retrospectively analyzing the clinical outcome of surgical patients with Stanford type A aortic dissection（AAD）.Methods From June 2015 to December 2016, 39 consecutive patients with AAD were recruited to this study. This modified technique was preformed under general anesthesia and a 30℃ hypothermia circulatory arrest（HCA） with continual bilateral antegrade cerebral perfusion. Different surgical approaches were applied according to the aortic root condition： Bentall procedure（4 patients）, David procedure（2 patients）, aortic valve plasty and ascending aortic replacement（25 patients） and Cabrol procedure（8 patients）. Concomitant procedures included mitral valve plasty（1 patient） and tricuspid valve plasty（1 patient）. Results The average cardiopulmonary bypass（CPB）, aortic occlusion time（ACC）, HCA and operation time was 218.5±42.2 min, 134.2±32.4 min, 4.9±2.3 min and 415.5±80.5 min respectively.Four patients required dialysis and 2 patients developed temporary neurological deficit. No permanent neurological deficit,postoperative paraplegia or in-hospital death occurred. Computed tomography examination was performed on all patients before discharge and 3 months after discharge. The follow-up result showed that 37 patients developed complete thrombosis in the false lumen and 2 patients developed partial thrombosis. Conclusion Modified total arch replacement is a safe and effective approach for AAD. It can greatly avoid postoperative complications and provide satisfactory short-term outcomes.
作者
蔡诗豪
范小平
黄劲松
彭继海
张鸣生
何杰
许文柳
CAI Shihao;FAN Xiaoping;HUANG Jinsong;PENG Jihai;ZHANG Mingsheng;HE Jie;XU Wenliu(Department of Cardiovascular Surgery,Guangdong Cardiovascular Institute,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Department of Rehabilitation,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;Graduate School,the Second School of Clinical Medicine,Southern Medical University,Guangzhou,510515,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2018年第11期962-966,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
广东省自然科学基金面上项目(2016A030313792)
广东省医学科学技术研究基金面上项目(2016115114137325)
广东省中医药局科研项目(20161003)
国家自然科学基金面上项目(81372114)
关键词
主动脉夹层
外科治疗
低温
选择性脑灌注
Aortic dissection
surgery
hypothemia
selective cerebral perfusion
