【摘要】 目的总结不同手术方式治疗急性Stanford A型主动脉夹层的临床经验。方法回顾性分析2008年1月至2012年11月于中国医科大学附属第一医院因急性Stanford A型主动脉夹层而实施外科治疗的197例患者的临床资料。男131例、女66例,年龄(51.2±13.9)岁。所有患者经磁共振成像(MRI)或主动脉CT血管造影(CTA)确诊。根据主动脉根部病变情况,进行单纯升主动脉置换、Bentall、Wheat、Cabrol或David手术。主动脉弓部进行全主动脉弓置换、半弓置换或简化全主动脉弓置换+降主动脉支架象鼻手术。结果近端单纯升主动脉置换113例(57.4%),Bentall手术67例(34.0%),Wheat手术13例(6.6%),Cabrol手术1例(0.5%),David手术3例(1.5%)。全主动脉弓置换+降主动脉支架象鼻手术82例(41.6%),半弓置换+降主动脉支架象鼻手术77例(39.1%),简化全主动脉弓置换+降主动脉支架象鼻手术41例(20.8%)。二次开胸止血1例(0.5%),无永久性神经系统并发症发生,手术30 d死亡率为4.1%(8/197);随访时间3~52(15.9±11.4)个月,随访率65.0%;1例马方综合征患者术后8个月死于腹主动脉瘤破裂。结论根据病变情况,选择适当的外科治疗策略,急性Stanford A型主动脉夹层外科治疗效果满意。更多还原

【Abstract】 Objective: To summarize clinical experience of different surgical strategies for the treatment of acute Stanford type A aortic dissection(AD). Methods Clinical data of 197 patients with acute Stanford type A AD who underwent surgical treatment in the First Affi liated Hospital of China Medical University from January 2008 to November 2012 were retrospectively reviewed. There were 131 males and 66 females with their age of 24-77(51.2±13.9) years. All the patients received magentic resonance imaging(MRI) or aortic CT angiography(CTA) for the establishment of diagnosis. According to different aortic root conditions,ascending aorta replacement,Bentall,Wheat,Cabrol or David procedures were performed. Total arch replacement, hemiarch replacement or simplifi ed total arch replacement was also performed for aortic arch dissection combined with stented elephant trunk implantation. Results A total of 113 patients(57.4%) underwent isolated ascending aorta replacement,67 patients(34.0%) received Bentall procedure,13 patients(6.6%) received Wheat procedure,1 patient(0.5%) received Cabrol procedure,and 3 patients(1.5%) received David procedure. Eighty-two patients(41.6%) underwent total arch replacement combined with stented elephant trunk implantation,77 patients(39.1%) received hemiarch replacement, and the other 41 patients(20.8%) received simplifi ed total arch replacement combined with stented elephant trunk implantation. One patient(0.5%) underwent reexploration for postoperative bleeding. No permanent neurological complication occurred. Thirty-day mortality after surgery was 4.1%(8/197). Follow-up duration was 3-52(15.9± 11.4) months with the follow-up rate of 65.0%. One patient with Marfan syndrome died of abdominal aortic aneurysm rupture 8 months after surgery. Conclusion According to different AD conditions, appropriate surgical strategies can be chosen to achieve satisfactory clinical outcomes for patients with acute Stanford type A AD.更多还原