昆明医学院学报2012，Vol.33Issue(1)：57-60,66,5.
Stanford A型胸主动脉夹层的外科治疗
Surgical Treatment of Standford Type A Dissection of Thoracic Aorta
摘要
Abstract
Objective To summarize the experience in surgical treatment of Standford type A dissection of thoracic aorta. Methods Between Jan 2001 and Feb 2010, 42 patients with type A dissection of thoracic aorta underwent surgical repair (DeBakey type I in 27cases and DeBakey type II in 15 cases) . The 42 patients included 33 cases of acute dissection (＜14 days) and 9 cases of chronic dissection O14 days). All patients were operated under cardiopulmonary bypass with femoral artery or right axillary artery cannulation. The strategies of brain protection were used in case of deep hypothermic circulatory arrest (DHCA) , during circulatory arrest, selective antegrade cerebral perfiision (SACP) was performed. Operative procedures: ascending aorta replacement was in 11, Bentall procedure was in 13, David procedure and hemiarch replacement was in 1, hemiarch replacement was in 3, hemiarch replacement and open stent grafting was in 3, total aortic arch replacement was in 5, total aortic arch replacement and open stent grafting was in 6. Selective operation was performed in 25 cases, and emergency operation was performed in 17 cases. Results Early postoperative complication rate was 40.5 % (17/42), which included coma in 1 patients, low cardiac ouput in 1, arrhythmia in 1, bleeding in 4, respiratory failure in 6 , acute renal failure in 2, upper gastrointestinal beeding in 2. The mortality rate was 16.7% (7/42) during perioperative period, other patients were cured and discharged from hospital. Conclusions Standford type A aortic dissection is a abrupt- onset and life- threatening medical emergency associated with high rates of morbidity and mortality, it requires timely and accurate diagnosis and surgical treatment. It can improve the success rate of surgical treatment by making a safe, simple and individualized surgery procedure that considering the skill of the surgical team, the location of rupture and the hemodynamic status of the patients, espically in emergerncy cases. The management skill of the proximal and distal anastomosis is a key factor to surgical success. Selective antegrade cerebral perfusion ( SACP) during deep hypothermic circulatory arrest (DHCA) can significantly reduce perioperative neurologic complications.关键词
胸主动脉夹层/外科治疗/体外循环Key words
Dissection of thoracic aorta/ Surgical treatment/ Extracorporeal circulatin分类
医药卫生引用本文复制引用
杨绍军,周云,向利,李旭,王曦..Stanford A型胸主动脉夹层的外科治疗[J].昆明医学院学报,2012,33(1):57-60,66,5.基金项目
云南省科技计划基金资助项目(2008CD026) （2008CD026）
云南省卫生科技计划基金资助项目(2009NS076) （2009NS076）
