• 中國(guó)醫(yī)科大學(xué)附屬第一醫(yī)院心臟外科，沈陽(yáng) 110001;

目的總結(jié)和評(píng)價(jià)“改良”次全弓置換加支架象鼻手術(shù)治療 Stanford A 型主動(dòng)脈夾層患者的臨床療效。方法 2009年 12月至 2011年 1月，中國(guó)醫(yī)科大學(xué)附屬第一醫(yī)院接收 47例 Stanford A 型主動(dòng)脈夾層患者行“改良”次全弓置換加支架象鼻手術(shù)，其中男 35例，女 12例；年齡 29～86（57.9±16.0）歲?；颊呔罁?jù)術(shù)前主動(dòng)脈
計(jì)算機(jī)斷層掃描動(dòng)脈成像診斷分型，在深低溫停循環(huán)選擇性腦灌注下施行手術(shù)；近心端采用升主動(dòng)脈置換術(shù) 29例，Bentall手術(shù) 11例，Wheat手術(shù) 4例， David手術(shù) 3例；同期行冠狀動(dòng)脈旁路移植術(shù)（CABG）5例。結(jié)果體外循環(huán)時(shí)間（136±32）min，主動(dòng)脈阻斷時(shí)間（97±28）min，深低溫停循環(huán)選擇性腦灌注時(shí)間（27±11）min。47例患者中住院期間死亡 2例（4.25%，2/47），術(shù)后一過(guò)性精神障礙 2例（4.25%，2/47），術(shù)后出現(xiàn)截癱 1例（2.12%，1/47），二次開(kāi)胸止血 4例。生存的 45例患者均于出院前及術(shù)后 6個(gè)月行主動(dòng)脈 3維 CT血管造影（3D CTA）檢查顯示，降主動(dòng)脈內(nèi)支架血管膨脹良好，氣管隆突及腹腔干平面真腔較術(shù)前明顯擴(kuò)大（ P＜0.05）；術(shù)后隨訪 1～13個(gè)月，無(wú)因夾層進(jìn)展需二次手術(shù)及動(dòng)脈瘤破裂患者。結(jié)論“改良”次全弓置換術(shù)加支架象鼻手術(shù)是治療弓部三分支血管無(wú)破口的 Stanford A 型主動(dòng)脈夾層安全、有效的方法，改良之處在于簡(jiǎn)化手術(shù)，縮短了手術(shù)時(shí)間、體外循環(huán)和深低溫停循環(huán)時(shí)間，減少了手術(shù)相關(guān)并發(fā)癥的發(fā)生；近期效果良好。

引用本文： 谷天祥,于洋,師恩祎等. “改良”次全弓置換加支架象鼻手術(shù)治療Stanford A型主動(dòng)脈夾層. 中國(guó)胸心血管外科臨床雜志, 2012, 19(1): 4-7. doi: 復(fù)制

1. 　Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117（5）：1271-1278.
2. 　廖明芳, 景在平. 胸主動(dòng)脈夾層病因研究進(jìn)展. 中華普通外科雜志, 2005, 20（9）：606-608.
3. 　DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta： twenty-year follow-up of five hundred twenty-seven patients treated surgically.Surgey, 1982, 92（6）：1118-1134.
4. 　孫立忠, 劉志剛, 常謙, 等．主動(dòng)脈弓替換加支架“象鼻”手術(shù)治療Stanford A型主動(dòng)脈夾層．中華外科雜志, 2004, 42（13）：812-816．.
5. 　趙鑫, 常謙, 朱俊明, 等. 術(shù)后CT評(píng)價(jià)支架象鼻手術(shù)治療慢性Ⅰ型主動(dòng)脈夾層的降主動(dòng)脈重塑效果.中華醫(yī)學(xué)雜志, 2010,90（12）：830-833.
6. 　David TE, Armstrong S, lvanov J, et al．Surgery for acute type A aortic dissection．Ann Thorac Surg, 1999, 67（6）：1999-2001.
7. 　DeBakey ME, Cooley DA, Creech O Jr．Surgical treatment of aneurysms and occlusive disease of the aorta．Postgrad Med, 1954, 15（2）：120-127．.
8. 　Bernard Y, Zimmermann H, Chocron S, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol， 2001, 87（12）：1378-1382.
9. 　Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms lmproving early and long-term surgical results. Circulation, 1990, 82（5 Suppl IV）：IV24-38.
10. 　Rizzo RJ, Aranki SF, Aklog L, et al. Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection.lmproved survival with less angiography. J Thorac Cardiovasc Surg, 1994, 108（3）：567-575.
11. 　Lytle BW, Mahfood SS, Cosgrove DM, et al. Replacement of the ascending aorta：Early and late results. J Thorac Cardiovasc Surg, 1990, 99（4）：651-658.
12. 　Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138（6）：1358-1362.
13. 　Bakaeen FG, Chu D, Huh J, et al. Outcomes of circulatory arrest procedures for the treatment of thoracic aortic disease at a veterans facility. Am J Surg, 2010, 200（5）：581-584.
14. 　Heinemann M, Laas J, Jurmann M, et al. Surgery extended into theaortic arch in acute type A dissection. Indications, techniques, and results. Circulation, 1991, 84（5 Suppl）：III 25-30.
15. 　Kirklin JW, Kouchoukos NT. When and how to include arch repair in patients with acute dissections involving the ascending aorta. Semin Thorac Cardiovasc Surg, 1993, 5（1）：27-32.
16. 　Hirotani T, Kameda T, Kumamoto T, et al. Results of a total aorticarch replacement for an acute aortic arch dissection. J Thorac Cardiovasc Surg, 2000, 120（4）：686-691.
  1. 1. 　Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117（5）：1271-1278.
  2. 2. 　廖明芳, 景在平. 胸主動(dòng)脈夾層病因研究進(jìn)展. 中華普通外科雜志, 2005, 20（9）：606-608.
  3. 3. 　DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta： twenty-year follow-up of five hundred twenty-seven patients treated surgically.Surgey, 1982, 92（6）：1118-1134.
  4. 4. 　孫立忠, 劉志剛, 常謙, 等．主動(dòng)脈弓替換加支架“象鼻”手術(shù)治療Stanford A型主動(dòng)脈夾層．中華外科雜志, 2004, 42（13）：812-816．.
  5. 5. 　趙鑫, 常謙, 朱俊明, 等. 術(shù)后CT評(píng)價(jià)支架象鼻手術(shù)治療慢性Ⅰ型主動(dòng)脈夾層的降主動(dòng)脈重塑效果.中華醫(yī)學(xué)雜志, 2010,90（12）：830-833.
  6. 6. 　David TE, Armstrong S, lvanov J, et al．Surgery for acute type A aortic dissection．Ann Thorac Surg, 1999, 67（6）：1999-2001.
  7. 7. 　DeBakey ME, Cooley DA, Creech O Jr．Surgical treatment of aneurysms and occlusive disease of the aorta．Postgrad Med, 1954, 15（2）：120-127．.
  8. 8. 　Bernard Y, Zimmermann H, Chocron S, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol， 2001, 87（12）：1378-1382.
  9. 9. 　Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms lmproving early and long-term surgical results. Circulation, 1990, 82（5 Suppl IV）：IV24-38.
  10. 10. 　Rizzo RJ, Aranki SF, Aklog L, et al. Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection.lmproved survival with less angiography. J Thorac Cardiovasc Surg, 1994, 108（3）：567-575.
  11. 11. 　Lytle BW, Mahfood SS, Cosgrove DM, et al. Replacement of the ascending aorta：Early and late results. J Thorac Cardiovasc Surg, 1990, 99（4）：651-658.
  12. 12. 　Sun LZ, Qi RD, Chang Q, et al. Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation experience with 107 patients. J Thorac Cardiovasc Surg, 2009, 138（6）：1358-1362.
  13. 13. 　Bakaeen FG, Chu D, Huh J, et al. Outcomes of circulatory arrest procedures for the treatment of thoracic aortic disease at a veterans facility. Am J Surg, 2010, 200（5）：581-584.
  14. 14. 　Heinemann M, Laas J, Jurmann M, et al. Surgery extended into theaortic arch in acute type A dissection. Indications, techniques, and results. Circulation, 1991, 84（5 Suppl）：III 25-30.
  15. 15. 　Kirklin JW, Kouchoukos NT. When and how to include arch repair in patients with acute dissections involving the ascending aorta. Semin Thorac Cardiovasc Surg, 1993, 5（1）：27-32.
  16. 16. 　Hirotani T, Kameda T, Kumamoto T, et al. Results of a total aorticarch replacement for an acute aortic arch dissection. J Thorac Cardiovasc Surg, 2000, 120（4）：686-691.