孙氏手术治疗急性Stanford B型主动脉夹层累及主动脉弓临床经验

摘要

目的 回顾性总结孙氏手术(全主动脉弓替换联合支架象鼻手术)治疗急性Stanford B型主动脉夹层累及主动脉弓的临床经验.方法 收集2009年2月至2015年12月首都医科大学附属北京安贞医院心脏外科收治的26例急性Stanford B型主动脉夹层累及主动脉弓行孙氏手术患者的临床资料.均采用Cronus支架人工血管进行孙氏手术.术后随访,分别于术后出院前、术后3或6个月、术后每年根据远端主动脉重塑情况复查CT,评价胸降主动脉直径和假腔状态.结果 平均体外循环时间、心肌阻断时间、选择性脑灌注时间分别为(171 ±43)、(91±26)、(27±8)min.术后院内死亡1例(3.8％),死因为脑梗死;随访期间死亡1例,原因不明;术后肾功能不全1例,消化道出血1例,心包开窗2例.随访(44±24)个月期间,支架象鼻远端假腔闭合率为84.0％ (21/25),支架象鼻以远水平假腔闭合率为60.0％(15/25),膈肌水平假腔闭合率为36.0％ (9/25),腹腔干水平假腔闭合率为16.0％ (4/25).结论 孙氏手术治疗急性Stanford B型主动脉夹层累及主动脉弓患者,同期解决主动脉弓近端病变和降主动脉夹层,获得了满意的临床效果.%Objective To review experiences of Sun's procedure(total aortic arch replacement combined with stented "elephant trunk" implantation) in treatment of acute Stanford type B aortic dissection involving aortic arch.Methods Clinical data of 26 cases of acute Stanford type B aortic dissection with aortic arch involvement from February 2009 to December 2015 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.Sun's procedure was performed using Cronus stented graft.Aortic remodeling was assessed through regular follow-up after operation.Results Mean cardiopulmonary bypass time,aortic cross-clamp time and selective antegrade cerebral perfusion time were (171 ± 43),(91 ± 26),(27 ± 8) min,respectively.Major postoperative complications included 2 cases of pericardial drainage,1 case of renal dysfunction and 1 case of gastrointestinal bleeding;1 case of cerebral infarction died in hospital;the in-hospital mortality was 3.8％.One case died during follow-up.During (44± 24)months of follow-up,distal stent-graft false lumen closure rate was 84.0％ (21/25);extending stent-graft false lumen closure rate was 60.0％ (15/25);aortic false lumen closure rate was 36.0％ (9/25) at diaphragm and 16.0％ (4/25) at celiac trunk.Conclusion Sun's procedure has good curative effect on acute Stanford type B aortic dissection involving aortic arch.