孙氏手术治疗74例Stanford A型主动脉夹层

The clinical applied reseach on the treatment of Stanford type A aortic dissection by Sun＇ s procedure

目的总结应用孙氏手术治疗StanfordA型主动脉夹层的临床经验。方法回顾性分析2010年5月至2013年8月收治的74例StanfordA型主动脉夹层患者临床资料，男67例，女7例；急性67例，慢性7例，全部按孙氏手术技术准备。结果采用标准孙氏手术71例，其中主动脉根部成形34例，Bentall术10例；行升主动脉置换加次全弓替换2例，升主动脉加全弓替换1例。术后低氧血症45例，明显精神症状23例，脊髓损伤、截瘫2例，脑出血2例，急性肾功能衰竭（AFR）11例，双下肢功能障碍1例。住院死亡4例（5．4％，4／74），自动出院2例。15例失访；53例患者随访1～42个月，随访率77．9％（53／68）。1例术后1个月在外院行截肢手术，1例术后6个月因降主动脉起始部假性动脉瘤行覆膜支架置入术，1例发生脑部窃血综合征。复查CTA显示，24例胸降主动脉夹层假腔血栓化而腹主动脉仍为夹层改变，15例支架“象鼻”远端夹层假腔完全血栓化，14例支架“象鼻”远端降主动脉仍为夹层改变。结论对确诊的Stanford A型主动脉夹层患者，尽早行孙氏手术能有效减少死亡，降低严重并发症的发生率。孙氏手术可实现重建真腔的目的，改善长期预后。

Objective To summarize the clinical experience on the treatment of Stanford type A aortic dissection by SUN＇ s procedure. Methods Retrospectively analyzed 74 patients of Stanford type A aortic dissection between May 2010 and August 2013. Sixty-seven cases were male and 7 cases were female. Sixty-seven cases were acute and 7 cases were chronic. All patients were prepared to be performed in according to SUN＇ s procedure. Results Standard SUN＇ s procedure was performed in 71 patients, thirty-four cases of which were underwent aortic root patch angioplasty and 10 cases were underwent Bentall operation. In addition, the operation procedure included ascending aorta replacement and semi arch replacement in 2 cases, as- cending aorta replacement and arch replacement in 1 cases. Postoperative hypoxenfia was observed in 45 patients, obvious mental symptoms was observed in 23 patients, spinal cord injury and paraplegia was observed in 2 cases, cerebral hemon＇hage was obser, ed in 2 cases, acute renal failure（AFR） was observed in 11 cases and dysfunction of lower limbs was observed in 1 ca- ses. In-hospital mortality was 5.4% （4/74）, and 2 patients were automatic discharge. During a follow-up of 1 month to 42 months, 53 patients were adhere to follow-up, follow-up rate is 77.9%. There is one patient was imposed amputation in other hospital in postoperative one month ; one was performed aortic stent implantation for the false aneurysm of starting of descending aorta in postoperative 6 months; brain stolen blood syndrome was observed in 1 case. On postoperative computed tomography, complete thrombus formation was observed in false lumen after the stented elephant trunk in 15 cases; thrombus formation was observed only in false lumen of thoracic descending aortic dissection except abdominal aorta in 24 eases; aorta dissection was still observed in far side of stented elephant trunk in 14 cases. Conclusion To be performed SUN＇ s procedure as early as possible can effectively reduce the mortality and the rate of serious complications. The application of SUN＇ s procedure can largely help reconstruct the true lumen and improve the long-term prognos.