Objective To evaluate the clinical efficacy and safety of Sun's surgery in patients with acute Stanford type A aortic dissection. Methods From July 2013 to July 2017, 39 patients with acute Stanford type A aortic dissection in Meizhou People's Hospital were selected and treated with Sun??s surgery under deep hypothermia with circulatory arrest and low flow selective cerebral perfusion. Length of stay in ICU and hospitalization, incidence of recent and long-term complications and mortality were recorded, and the changes of left ventricular end-diastolic inner diameter ( LVEDd ), left ventricular ejection fraction (LVEF) and maximum inner diameter of ascending aorta were compared between preoperative and post-operative 12-month follow-up. Results The mean intraoperative extracorporeal circulation time, mean aortic occlusion time and mean cerebral perfusion time were (223. 52 ± 51. 72) min, (143. 71 ± 34. 81) min and (33. 72 ± 7. 53) min, respectively. There were 2 perioperative deaths (5. 1% , 2/39), 1 of which was caused by renal failure and 1 of which was caused by multiple organ failure. The length of stay in ICU of 37 patients was (6. 2 ± 1. 7) d, and the length of stay was (26. 9 ± 6. 2) d. After follow-up for 12 months, 35 patients survived postoperatively, of which LVEDd and diameter of ascending aorta were significantly decreased [(50. 87 ± 4. 27) mm vs. (55. 02 ± 6. 81) mm, (28. 19 ± 3. 61) mm vs. ( 48. 85 ± 7. 93 ) mm], and LVEF was significantly increased ( 61% ± 9% vs. 47% ± 12% , t =13. 726, 52. 417 and 24. 208, respectively, all P<0. 001). The incidence of perioperative complications was 23. 1% (9/39). Two patients died of re-rupture of aorta 12 months after operation, with a mortality rate of 5. 4% (2/37). Conclusions Sun's surgery for acute Stanford type A aortic dissection can significantly reduce perioperative mortality, improve long-term cardiac function, and reduce the incidence of complications.%目的 评价孙氏手术治疗急性Stanford A 型主动脉夹层的临床疗效及安全性. 方法选择2013年7月至2017年7月梅州市人民医院39例急性Stanford A 型主动脉夹层患者,均在深低温停循环、低流量选择性脑灌注下行孙氏手术治疗.记录患者ICU停留时间、住院时间,近期和远期并发症发生率和死亡率,比较术前与术后12个月随访时左心室舒张末期内径( LVEDd)、左心室射血分数(LVEF)和升主动脉最大内径变化. 结果 39 例患者术中平均体外循环时间(223. 52 ± 51. 72)min、平均主动脉阻断时间(143. 71 ± 34. 81)min、平均脑灌注时间(33. 72 ± 7. 53) min.围术期死亡2例(5. 1% ,2/39),1例为肾衰竭,1例为多脏器功能衰竭;围术期并发症发生率为23. 1% (9/39). 37例存活患者ICU停留时间为(6. 2 ± 1. 7) d,住院时间为(26. 9 ± 6. 2)d.术后随访12 个月, 2例患者主动脉再次破裂死亡,死亡率为5. 4% (2/37). 35例存活患者术后12个月时LVEDd和升主动脉最大内径为(50. 87 ± 4. 27)mm和(28. 19 ± 3. 61)mm,均明显小于术前的(55. 02 ± 6. 81)mm和(48. 85 ± 7. 93)mm,而LVEF为61% ± 9% ,明显大于术前的47% ± 12% ,差异均有统计学意义(t=13. 726、52. 417和24. 208,均为P<0. 001). 结论 孙氏手术治疗急性Stanford A 型主动脉夹层可显著降低围术期死亡率,改善远期心功能,同时降低并发症发生率.
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