个体化手术治疗急性主动脉夹层患者14例疗效观察

Clinical observation of 14 cases of patients with acute aortic dissection with individualized surgery

目的总结急性主动脉夹层的外科治疗方法及疗效。方法急性主动脉夹层患者14例,均经主动脉造影（CTA）、MR等检查确诊,其中急性Stanford A型夹层6例,复杂Stanford B型夹层1例,均行深低温停循环开放手术;复杂Stanford B型夹层患者7例,行一期两站式杂交手术。结果 14例患者均顺利出院,无围手术期死亡。术后发生并发症10例,经对症处理均治愈。术后门诊随访3~24个月,所有患者未见脑部和肢体缺血征象。复查主动脉CTA示人工血管通畅,吻合口无狭窄或渗漏,血管内支架无明显内漏及移位。所有患者术后生活质量良好。结论对急性主动脉夹层患者应根据病情、病变部位及夹层破口的位置,设计个体化的手术方式,尽快进行手术治疗,可提高手术及抢救成功率;停循环期间选择性顺性脑灌注可有效减少中枢神经系统并发症。

Objective To summarize the efficacy of surgical treatment of acute aortic dissection.Methods 14 patients with acute aortic dissection were underwent aortic CT angiography（CTA）,and MR examinations,these patients including acute Stanford A dissection of six cases,the complexity of Stanford B dissection of one case,underwent open surgery with deep hypothermic：circulatory arrest;7 patients with complicated Stanford type B dissection,were underwent two-stage hybrid surgery.Results 14 patients were discharged,no perioperative deaths.Postoperative complications occurred in 10 patients were cured afler symptomatic treatment.Outpatient follow-up after 3 to 24 months,all patients were reported with no signs of brain and limb ischemia.Follow up CTA shows aortic graft patency,no anastomotic stenosis or leakage,endovascular stent leakage and no significant shift.All patients with good quality of life.Conclusion For patients with acute aortic dissection should be based on the condition,lesion location and rupture point,design individualized surgical,and perform surgical treatment as soon as possible,and surgery can improve the success rate;during circulatory arrest,selective cerebral perfusion can be effective reducing the central nervous system complications.