目的：评价急性复杂型Stanford A 型主动脉夹层手术中改良双侧选择性顺行脑保护的效果及升主动脉插管、左锁骨下动脉（LSA）“开窗”技术对手术风险的影响。方法122例急性复杂型Stanford A 型主动脉夹层患者行改良全主动脉弓置换加降主...目的：评价急性复杂型Stanford A 型主动脉夹层手术中改良双侧选择性顺行脑保护的效果及升主动脉插管、左锁骨下动脉（LSA）“开窗”技术对手术风险的影响。方法122例急性复杂型Stanford A 型主动脉夹层患者行改良全主动脉弓置换加降主动脉内支架象鼻植入术，按照脑保护及动脉供血管插管方式分为单侧脑保护组与改良双侧脑保护组及右锁骨下动脉（RSA）插管组与主动脉插管组，比较各组的手术方式、死亡率及并发症率。部分患者采用左锁骨下动脉“开窗”技术重建血运。结果单侧脑保护组与改良双侧脑保护组总的院内死亡率分别为5．77％、2．86％，差异无统计学意义（P值为0．650）；神经系统总并发症率分别为26．92％、10．00％，差异有统计学意义（P值为0．014）。右锁骨下动脉插管组与升主动脉插管组总的院内死亡率均为4．55％，总并发症率分别为15．9％、15．2％，差异均无统计学意义（P值分别为1、0．914）。左锁骨下动脉“开窗”者术后多次复查CTA左锁骨下动脉均通畅，无左锁骨下盗血综合征发生，1例出现无需处理的少量内漏。结论改良双侧选择性顺行脑保护安全、可行、可靠；选择升主动脉插管符合生理、操作简捷，不增加手术风险；左锁骨下动脉“开窗术”简化了手术，缩短了深低温停循环时间，增加了手术安全性。展开更多
Extensive aneurysms involving the ascending aorta, aortic arch, and the descending aorta stand as a therapeutic dilemma in simultaneous management of multiple sites of pathology of the aortic arch and the descending t...Extensive aneurysms involving the ascending aorta, aortic arch, and the descending aorta stand as a therapeutic dilemma in simultaneous management of multiple sites of pathology of the aortic arch and the descending thoracic aorta. We systematically reviewed about literatures of stented elephant trunk operation （SET） identified through searches of the electronic databasesEMBASE and Medline, and aimed to summarize studies of patients undergoing SET for extensive aneurysms. Since 1996, Kato Mintroduced a hybrid technique by using stented graft implantation to the descending aorta for treatment of thoracic aortic aneurysm or dissection. It has been describe a good option for extensive thoracic aortic aneurysms and in a fashion similar to the elephant trunk technique.展开更多
文摘目的：评价急性复杂型Stanford A 型主动脉夹层手术中改良双侧选择性顺行脑保护的效果及升主动脉插管、左锁骨下动脉（LSA）“开窗”技术对手术风险的影响。方法122例急性复杂型Stanford A 型主动脉夹层患者行改良全主动脉弓置换加降主动脉内支架象鼻植入术，按照脑保护及动脉供血管插管方式分为单侧脑保护组与改良双侧脑保护组及右锁骨下动脉（RSA）插管组与主动脉插管组，比较各组的手术方式、死亡率及并发症率。部分患者采用左锁骨下动脉“开窗”技术重建血运。结果单侧脑保护组与改良双侧脑保护组总的院内死亡率分别为5．77％、2．86％，差异无统计学意义（P值为0．650）；神经系统总并发症率分别为26．92％、10．00％，差异有统计学意义（P值为0．014）。右锁骨下动脉插管组与升主动脉插管组总的院内死亡率均为4．55％，总并发症率分别为15．9％、15．2％，差异均无统计学意义（P值分别为1、0．914）。左锁骨下动脉“开窗”者术后多次复查CTA左锁骨下动脉均通畅，无左锁骨下盗血综合征发生，1例出现无需处理的少量内漏。结论改良双侧选择性顺行脑保护安全、可行、可靠；选择升主动脉插管符合生理、操作简捷，不增加手术风险；左锁骨下动脉“开窗术”简化了手术，缩短了深低温停循环时间，增加了手术安全性。
文摘Extensive aneurysms involving the ascending aorta, aortic arch, and the descending aorta stand as a therapeutic dilemma in simultaneous management of multiple sites of pathology of the aortic arch and the descending thoracic aorta. We systematically reviewed about literatures of stented elephant trunk operation （SET） identified through searches of the electronic databasesEMBASE and Medline, and aimed to summarize studies of patients undergoing SET for extensive aneurysms. Since 1996, Kato Mintroduced a hybrid technique by using stented graft implantation to the descending aorta for treatment of thoracic aortic aneurysm or dissection. It has been describe a good option for extensive thoracic aortic aneurysms and in a fashion similar to the elephant trunk technique.
