西安交通大学学报（医学版）2017，Vol.38Issue(5)：768-772,5.DOI:10.7652/jdyxb201705030
老年Stanford A型急性主动脉夹层的手术治疗
Surgical treatment of Stanford type A acuteaortic dissection in elderly patients
摘要
Abstract
Objective To review our surgical treatment experience and analyze the surgical methods and efficacy of Stanford type A acute aortic dissection in elderly patients.Methods We recruited 24 patients aged over 60 years with Stanford type A acute aortic dissection treated surgically with deep hypothermic circulatory arrest and selective cerebral perfusion from June 2013 to September 2016.Depending on the patients` conditions, we selected different surgical methods, including Bentall operation in 3 cases, David operation in 1 case, partial aortic arc replacement+Bentall operation in 3 cases, total aortic arch replacement+stented elephant trunk implantation technique+Bentall operation in 12 cases, total aortic arch replacement+stented elephant trunk implantation technique+ascending aorta replacement in 5 cases, and concomitant coronary artery bypass grafting (CABG) in 3 cases.Results Surgical operation was successful in all the 24 patients.The average CPB time of the all patients was (192.9±37.1)min, the aortic cross-clamp time was (120±28.72)min, deep lower temperature of cerebral perfusion time was (36.2±11.3)min, and operation time was (544.8±91.2)min.Soon after the operation, two patients died of multiple organ dysfunction syndrome and renal failure complicated with infection, respectively.Postoperative complications included brain nerve dysfunction in 2 cases;renal insufficiency in 4 cases, which werelater treated with CRRT;pulmonary infection and tracheotomy in 3 cases;dysfunction in lower extremities in 1 case;hyoxemia in 3 cases;and incision infection in 2 cases.All the patients were followed up for 2-38 months, one patient was hospitalized because of hydropericardium and another one died of sudden death with unclear cause.Conclusion Surgical treatment of Stanford type A acute aortic dissection can obviously decrease the mortality and improve the quality of life.Total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is a classic clinical surgical treatment.Precise diagnosis, suitable surgical treatment and post-operative care are all important factors contributing to patients` recovery.关键词
急性主动脉夹层/老年/手术治疗/并发症Key words
acute aortic dissection/elderly people/surgical treatment/complication分类
医药卫生引用本文复制引用
陆政日,法宪恩,王宏山..老年Stanford A型急性主动脉夹层的手术治疗[J].西安交通大学学报（医学版）,2017,38(5):768-772,5.基金项目
国家自然科学基金资助项目(No.81241003) （No.81241003）
河南省教育厅科学技术研究重点项目资助计划资助项目(No.12A320026) （No.12A320026）
河南省科技创新杰出人才计划资助项目(No.104200510007) Supported by the National Natural Science Foundation of China (No.81241003) （No.104200510007）
The Project of Henan Educational Department Science and Technology Research (No.12A320026) （No.12A320026）
and the Plan for Scientific Innovation Excellent Talents of Henan Province (No.104200510007) （No.104200510007）
