三分叉支架血管在StanfordA型主动脉夹层外科治疗中的应用

The application of triple-branched stent graft implantation in the surgical treatment of Stanford type A aortic dissection

目的总结运用三分叉支架血管外科治疗主动脉夹层的经验。方法2010年3月至2012年5月，运用三分叉支架血管共治疗32例患者作为治疗组，同期采用传统升主动脉置换＋主动脉弓置换＋支架象鼻术式手术33例患者作为对照组，分析比较两组术中术后各项指标。结果治疗组无围手术期死亡，无二次开胸止血，术后短暂性脑功能障碍（嗜睡、谵妄、狂躁等）3例，肾功能不全2例，肺部感染3例；对照组围手术期死亡2例，二次开胸2例，术后胸骨后感染3例，术后持续昏迷1例，肾功能不全、持续血液滤过1例，肺部感染1例。随访63例（96．9％），平均随访时间（1．1±0．4）年。随访期治疗组cT证实内瘘2例，均为支架血管远端内瘘，对照组术后半年胸骨后感染、突发室性恶性心律失常死亡1例，余患者良好。结论采用三分叉支架血管治疗Stan．fordA型主动脉夹层简易、安全、有效。远期结果有待观察。

Objective To summarize the experience of triple-branched stent graft implantation in the surgical treatment of aortic dissection. Methods From March 2010 to May 2012 ,a total of 32 patients accepted triple-branched stent graft implantation procedure （treatment group）, The other 33 patients were treated by means of ascending aortic replacement, aortic arch replacement and stented elephant trunk im- plantation procedure in the corresponding period （control group）. Intraoperative and postoperative indica- tors were analyzed and compared between the two groups. Results In treatment group, there was no hospi- tal mortality or secondary thoracotomy. Transient brain dysfunction including somnolence, delirium and ma- nia occurred in 3 patients ; renal insufficiency occurred in 2 patients and pulmonary infection occurred in 3 patients. In control group, there were 2 cases of hospital deaths,2 cases of secondary thoracotomy,3 cases of substernal infection, 1 case of persistent coma, 1 case of renal insufficiency and 1 case of pulmonary in- fection. Sixty-three patients（96.9% ）were followed up with a mean follow-up period of 1.1 ±0.4 years. There were two cases of internal fistula at the distal end of the stent by CT diagnosis in treatment group. One patient died suddenly from severe substernal infection and malignant ventricular arrhythmia 6 months after operation in control group. All the other patients remained well. Conclusion Triple-branched stent graft implantation is an easy, safe and effective method fbr the treatment of Stanford type A aortic dissec- tion. More observation is needed to confirm the long-term results.