一期次全或全主动脉替换术的临床应用

Clinical application of total or subtotal aortic replacement on the one stage

目的总结全主动脉替换术治疗全程主动脉瘤及慢性Stanford A型主动脉夹层的临床经验.方法 2004年2月至11月对8例全程主动脉瘤或慢性Stanford A型主动脉夹层的患者施行一期次全(2例)或全主动脉替换术(6例).其中7例男性,1例女性,年龄23～47岁.病因均为马凡综合征.手术均在全身麻醉深低温停循环顺行性脑灌注下进行.采用左后外胸腹联合切口及胸骨正中切口.手术采用四分支人工血管,先行升主动脉替换或Bentall手术,然后行主动脉弓替换,最后完成胸腹主动脉替换. 结果无手术及住院死亡.1例脑梗死.随访2～12个月,无晚期死亡及再手术病例.结论一期次全或全主动脉替换术可减少分期手术的痛苦,节约医疗费用,并消除分期手术残余动脉瘤破裂的风险,是治疗全程主动脉瘤及慢性Stanford A型主动脉夹层的有效方法.

Objective To summerize the experience of the application of total and subtotal aortic replacement on the one stage in the treatment of the patients with extensive aortic aneurysm and chronic Stanford type A dissecting aneurysm. Methods From February to November 2004, 8 patients （7 male and 1 female ; ranging from 23 to 47 years old ） underwent one-stage total or subtotal aortic replacement under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Two patients received subtotal aortic replacement（ from the aortic valve to the abdominal aorta）. Six patients underwent total aortic replacement （from the aortic valve to the aortic bifurcation ）, of which 3 patients had aortic valve replacement. Patients were with mid-stemotomy and thoracoabdominal incision. The ascending aorta was firstly replaced, following which the aortic arch was reconstructed. Finally, the thoracoabdominal aorta was fully replaced. Results There was no operative or early postoperative death. One patient had cerebral infarction secondary to embolism. Spinal neurological deficits didni occur. All 8 patients were alive and had good functional status 2 to 12 months after operation. Conclusion The patients performed with one-stage total and subtotal aortic replacement achieves good results. It can eliminate the risk of remnant aneurysm rupture in staged total aortic replacement.