全弓替换加支架象鼻技术治疗复杂Standford B型主动脉夹层的临床观察

Clinical application of stented elephant trunk technique for complicated Stanford type B aortic dissection

目的总结应用全弓替换加支架象鼻技术治疗复杂型StandfordB型主动脉夹层的临床经验及中期效果。方法2004年1月至2009年3月共33例复杂型StandfordB型主动脉夹层患者接受全弓替换加支架象鼻手术，其中男27例，女6例，平均年龄（44±11）岁（22～68岁）。同期行二尖瓣置换术（MVR）1例，左室流出道疏通1例，冠状动脉旁路移植（CABG）1例。术后随访CT观察假腔的闭合情况，并记录不良事件（死亡、心脑血管事件）发生率。结果平均体外循环时间（174±29）min，选择脑灌注时间（24±9）min。术后死亡2例，死因为多脏器功能衰竭；无截瘫发生；二次开胸止血1例；随访29例，随诊率93．5％（29例／31例），平均随访时间29个月，随访期死亡1例，2例马凡综合征患者接受二次替换胸腹主动脉手术并存活。结论全弓替换加支架象鼻技术治疗复杂B型夹层早中期能够降低手术病死率及并发症的发生率，中期随访证实能够促使假腔内血栓的形成、封闭假腔。

Objective To summarize the experience of the application of stented elephant trunk procedure in the treatment of the patients with complicated Stanford type B aortic Dissection. Methods Between January 2004 and March 2009, 33 patients （27 male and 6 female ） underwent stented elephant trunk implantation in the descending aorta for complicated type B dissection. Right axilary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion. The stented elephan trunk was implanted through the aortic arch under hypothermic circulatory arrest. Complications were recorded to evaluate the immediate and mid-term results. Results Cardiopulmonary bypass time was 174 ± 29 rain, and average selective cerebral perfusion and lower body arrest time was 24±9 min. The in-hospital mortality was 6. 0% （2/33）. No paraplegia was observed after surgery. During follow-up CT-scans thrombus formation was observed within the descending aortic false lumen excluded by the stentod graft in the acute and chronic aortic dissections. There was one death during follow-up. Conclusions The stented elephant trunk procedure could be an effective treatment for complicated type B dissection; it also could close the false lumen of the descending aorta and in preventing expansion of the descending aorta.