Enblock技术治疗合并近端根/升/弓部主动脉瘤变的Stanford B型夹层

摘要

目的 总结Enblock技术治疗合并近端主动脉瘤变(包括主动脉根部、升主动脉、主动脉弓)的Standford B型夹层的临床疗效.方法 2011年6月至2015年10月,20例合并近端升、弓部主动脉瘤变的Stanford B型主动脉夹层患者采用Enblock技术行全主动脉弓替换,其中男15例、女5例,年龄22～ 65岁,平均(40.65±13.55)岁.近端主动脉合并症包括:升主动脉瘤10例,主动脉根部瘤8例和主动脉弓部瘤2例.结果 患者均在低温体外循环下完成手术.同期行解剖外旁路血管手术15例,Bentall手术15例,升主动脉替换5例.术后出院前均行CT血管造影(CTA)检查.手术历时(6.48±1.01) h(4.5～9.0 h),体外循环(173.60 ±48.39) min,主动脉阻断(91.25 ±28.63) min(51～ 165 min)、平均选择性脑灌注(27.25 ±6.80) min(17～43 min),选择性脑灌注鼻咽温度(23.77±1.27)℃(21.6℃～26℃).无手术死亡.随访时复查主动脉CTA.术后2例失访,18例随访(32.44 ±17.27)个月(8～ 60个月).术后再次行主动脉干预2例.随访期间1死于远端主动脉破裂,其余患者无并发症.结论 Enblock技术是一个相对简单的外科方法,对治疗合并近端主动脉瘤变的Stanford B型夹层是安全有效的.%Objective To summarize the clinical results of the surgical treatment for Stanford B aortic dissection patients with proximal aortic aneurysm(including aortic root,ascending,arch) by enblock technique.Methods From Jun.2011 to Oct.2015,20 patients with Stanford type B aortic dissection and proximal aortic aneurysm underwent open surgery by enbloc technique in our center.Among them,there were 15 male and 5 female.Average age of patients was(40.65 ± 13.55) years (range:22-65 years).The comorbidities of proximal aortic diseases are ascending aortic aneurysm in 10,aortic root aneurysm in 8,and aortic arch aneurysm in 2.All the surgeries were accomplished by hypothermic cardiopulmonary bypass assist.The combined surgery includes:extra-anatomy bypass grafting in 16,Bentall procedure in 15,ascending aortic repair in 5.Before surgery and discharged from hospital computed tomography angiography(CTA) was performed in each patient.All patients except 2 were followed.During the follow-up,CTA was performed and recorded.Results The average operation time,cardiopulmonary bypass time,aortic clamping time and selective cerebral perfusion (SCP) time are (6.47 ± 1.01)h (4.5-9 h),(173.60 ± 43.39) min (109-303 min),(91.25 ± 28.63) min (51-165 min),(27.25 ± 6.80) min (17-43 min),respectively.The mean nasopharyngeal temperature during SCP is(23.77 ± 1.27)℃ (21.6-26℃).There were no operative deaths.The mean follow-up time is (32.44 ± 17.27)months (range:8-60 months).Two patients underwent aortic re-intervention during follow-up.And 2 patients were lost follow-up(The follow-up rate is 90％).One late death was found.The patient succumbed to sudden distal aortic rupture.Other patients are survived without any complications.Conclusion Enblock technique is a relatively simple procedure in total aortic arch repair surgery.And it can be a safely surgical treatment for type B aortic dissection patients with proximal aortic aneurysm.The indications of enblock technique for Stanford B aortic dissection patients are those who combined with proximal aortic aneurysm.