单分支术支架人工血管在孙氏手术中的应用

Single branched open stent-graft in Sun's procedure

目的:探讨在主动脉夹层外科手术中,单分支术中支架血管是否与传统支架血管具有同等临床疗效及其技术简化作用。方法:将2011年1月至2012年2月,安贞医院收治的Stanford A型主动脉夹层患者按照入选、排除标准和知情同意原则,分为应用单分支术中支架人工血管的A组和应用传统术中支架血管的B组,分别行孙氏手术。结果:入组病例共63例,A组13例和B组50例,两组病死率(7.7%vs.6.0%,P>0.05)差异无统计学意义。两组手术时间、CPB时间、心脏阻断时间、停循环+选择性脑灌注时间、ICU时间、呼吸机时间和并发症发生率等,差异均无统计学意义(P>0.05)。两组内漏发生率、支架打折率和支架段假腔闭合率等差异也无统计学意义(P>0.05),无支架移位病例。结论:应用单分支术中支架人工血管,在降低孙氏手术的手术难度的同时,达到了与传统术中支架血管同等的临床疗效,证明应用单分支术中支架人工血管的孙氏手术治疗A型主动脉夹层的可行性。

Objective：To compare the clinical effects of Sun＇s procedure with single branched open stent-graft and straight open stent-graft.Methods ：From January 2011 to February 2012,63 patients with aortic dissection type A were divided into two groups： patients with total arch replacement combined with single branched stent elephant trunk implantation（Group A,n=13） and those with straight stent elephant trunk implantation（Group B,n=50）.Results：Mortality was not different in the two groups（A=7.7%,B=6.0%）.Operation duration,cardiopulmonary bypass,aortic cross-clamp,low-body arrest and selective cerebral perfusion times,duration of intensive care unit（ICU） stay and mechanical ventilation support were not different in the two groups.The incidence of post-operative complications did not differ in the two groups.The outcomes of postoperative computed tomography scans have no significant difference in the two groups.Conclusion：The single branched open stent-graft is able to lower the technical difficulties and simplify the surgical process of Sun＇s Procedure,showing the same effectiveness and safety with straight open stent-graft.Sun＇s procedure with single branched open branched stent-graft is an effective technique for type A aortic dissection.