急性Stanford A型主动脉夹层手术端端血管吻合技术的最新进展

Research progress on end-to-end anastomosis in surgical treatment of acute Stanford A aortic dissection

急性主动脉夹层手术技术难度大,术后死亡多与吻合口相关并发症有关,因此安全有效的端端血管吻合至关重要。血管吻合有直接吻合、动脉外膜内翻技术、"三明治"技术3种方法,其中后两种吻合方法均可有效止血,降低术后并发症发生。最近有相关文献报道动脉外膜内翻技术可以促进假腔血栓性闭合,提高患者远期生存率。本文同时还介绍2种改良吻合法,对急性Stanford A型主动脉夹层手术中不同血管吻合技术的应用及效果进行比较,探讨最值得临床推荐使用的血管吻合技术。

The surgical treatment of acute aortic dissection is difficult, and the mortality is associated with anastomosis site complications. Therefore, it is essential to make sure the end-to-end anastomosis safe and avoid bleeding.The methods of anastomosis include: direct anastomosis, adventitial inversion technique and sandwich technique. The latter two methods are both effective in hemostasis and reducing the postoperative complications. According to the recent literatures, the adventitial inversion technique may facilitate thrombotic closure of the false lumen in acute type A aortic dissection management and increase the long-term survival of the patients. This review introduces 2 modified methods of anastomosis as well, and summarizes clinical outcomes of different end-to-end anastomotic methods for surgical treatment of acute Stanford type A aortic dissection, in order to recommend the most proper method of end-to-end anastomosis.