摘要
目的:探讨Hybrid Ⅱ型主动脉弓修复术治疗Stanford A型主动脉夹层的疗效.方法:回顾性分析2020年10月至2021年12月应用Hybrid Ⅱ型主动脉弓修复技术治疗41例Stanford A型主动脉夹层患者的临床资料,其中男性29例,女性12例,年龄29～79岁,平均(54.51±11.66)岁,发病时间2～96 h.其中合并主动脉瓣关闭不全17例、夹层累及冠状动脉2例、脏器灌注不良5例、下肢供血障碍1例、高血压病36例、糖尿病4例、马方综合征2例.对围术期及随访结果进行分析.结果:手术成功率为100％,行升主动脉置换+主动脉弓去分支(Debranch)+主动脉支架置入术(TEVAR)16例,Bentall+Debranch+TEVAR 5例,窦部成形+升主置换+Debranch+TEVAR 20例.全组无单瘫、截瘫、昏迷等持续性神经功能障碍.术后意识模糊1例、躁动4例、谵妄2例.低氧血症15例、气管切开4例、肾功能衰竭行连续肾脏替代治疗5例.全组无延迟关胸、二次开胸止血及乳糜胸发生.随访6～12月,死亡2例,其中脑出血1例、重症感染1例(肺炎克雷伯杆菌).结论:Hybrid Ⅱ型主动脉弓修复技术治疗Stanford A型主动脉夹层,避免深低温停循环,缩短了手术及体外循环时间,明显降低了围术期并发症发生率及死亡率,近期效果良好.
Abstract
Objective:To investigate the efficacy of type Ⅱ hybrid total aortic arch repair in the treatment of Stanford type A aortic dissection.Methods:A retrospective study was performed on the clinical data of 41 Stanford type A aortic dissection patients,including 29 males and 12 females,who were treated by type Ⅱ hybrid total aortic arch repair technique from October 2020 to December 2021.The age ranged from 29 to 79 years,with an average age of(54.51±11.66)years,and the onset time ranged from 2 to 96 hours.There were 17 cases of aortic insufficiency,2 cases of coronary artery involve-ment by dissection,5 cases of organ malperfusion,1 case of lower limb blood supply disorder,36 cas-es of hypertension,4 cases of diabetes,and 2 cases of Marfan syndrome.The perioperative and follow-up results were analyzed.Results:The overall surgical success rate was 100％(41/41).For the de-tails of surgery,16 cases underwent ascending aorta replacement+Debranch+TEVAR procedure,5 cases underwent Bentall+Debranch+TEVAR,and 20 cases underwent aortic root plasty+ascend-ing aorta replacement+Debranch+TEVAR.No persistent neurological dysfunctions such as unilater-al paralysis,paraplegia,and coma were found.One case experienced confusion,4 cases experienced agitation,and 2 cases experienced delirium.There were 15 cases of hypoxemia,4 cases of tracheoto-my,and 5 cases of renal failure that received continuous renal replacement therapy.The delayed tho-racotomy,secondary thoracotomy for hemostasis,and chylothorax did not occur.During the follow-up period of 6-12 months,2 patients died,including 1 patient with cerebral hemorrhage and 1 patient with severe infection(Klebsiella pneumonia).Conclusion:Type Ⅱ hybrid total aortic arch repair has achieved a satisfactory therapeutic effect in the treatment of Stanford type A aortic dissection,which could avoid deep hypothermic circulatory arrest,shorten the time of operation and cardiopulmonary bypass,and significantly reduce the incidence of perioperative complications and mortality.
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