Stanford A型主动脉夹层的根部处理策略及疗效分析

Methods and results of surgical treatment for aortic root pathology due to Stanford A aortic dissection

目的探讨StanfordA型主动脉夹层根部处理的方法及疗效评价。方法回顾性分析2001年1月至2011年6月接受治疗的161例StanfordA型主动脉夹层患者的临床资料。男性122例，女性39例；平均年龄（44±21）岁。急性主动脉夹层146例，慢性主动脉夹层15例。主动脉根部均有不同程度的病变，其中左冠状动脉-无冠状动脉和（或）右冠状动脉-无冠状动脉交界撕脱140例，主动脉瓣中度以上反流75例，主动脉窦部内膜破口15例，左或右冠状动脉撕脱8例，左或右冠状动脉夹层16例，合并主动脉根部瘤31例。结果本组患者行主动脉根部置换（Bentall术）72例，主动脉根部重建（包括主动脉瓣置换术）80例，David手术9例。主动脉根部重建组心肺转流时间小于主动脉根部置换组及David手术组[（193±42）min，（210±61）min，（197±34）min；F=3．22，P=0．04]。全组住院死亡13例（8．1％）；主动脉根部置换组5例（6．9％），主动根部重建组7例（8．8％），David术组1例。死亡原因：呼吸功能衰竭4例，永久性神经功能障碍3例，多脏器功能不全4例，急性肾功能衰竭2例。生存者术后随访6个月至6年，无因主动脉根部病变而再行手术治疗者。主动脉根部重建组与David手术组术后效果差异无统计学意义（P〉0．05）。结论StanfordA型主动脉夹层导致主动脉根部病变，根据病变情况选择合理的手术方式，可取得较满意的疗效。

Objective To investigate the effectiveness of surgical approaches, outcomes and prognosis of aortic root pathology due to Stanford A aortic dissection. Methods Retrospective analysis the clinical data of 161 patients （122 male and 39 female, mean age of （44 -± 21 ） years） underwent surgical treatment for Stanford A aortic dissection between January 2001 and June 2011. There were 146 patients of acute aortic dissection and 15 patients of chronic aortic dissection. All the patients had aortic root pathologies that included commissural prolapsed in 140 cases, more than moderate aortic insufficiency in 75 cases, aortic sinus intima rupture in 15 cases, right and/or left coronary artery tearing in 8 cases, right and/or left coronary artery dissection in 16 cases, aortic root aneurysm in 31 cases. Results Aortic root replacement （Bentall procedures） were used in 72 cases, aortic root remodeling （including aortic valve replacement） in 80 cases, aortic root reimplantation （David procedure） in 9 cases. The cardiopulmonary bypass time was shorter in aortic root remodeling group （（ 193 ± 42） minutes） than the other two groups （（210 ± 61 ） minutes, （ 197 ± 34） minutes, F = 3.22, P = 0. 04）. The in-hospital mortality was 8. 1% （ 13 cases）, 5 cases（6. 9% ） in aortic root replacement group, 7 cases（8.8% ） in aortic root remodeling group, 1 case in aortic root reimplantation. The cause of death included respiratory failure （ 4 cases ） , permanent neurological deficits（3 cases）, multiple organ failure（4 cases）, acute renal failure（2 cases）. The survivors were followed up for 6 months to 6 years. There was no patient required reoperation for aortic root pathologies. There was no statistically significant difference between aortic root remodeling group and reimplantation group （ P 〉 0. 05 ）. Conclusions The surgical treatment for aortic root pathology due to Stanford A aortic dissection is challenging. Appropriate procedures according to the specialty of aortic rootpathology can be performed with favorable functional results.