一期行孙氏手术及升主动脉—股动脉转流术治疗小真腔慢性Stanford A型主动脉夹层

Sun＇s procedure and ascending aorta-femoral artery bypass treat chronic Stanford type A aortic dissection with small true lumen

目的 总结一期行孙氏手术及升主动脉-股动脉转流术治疗小真腔的慢性Stanford A型主动脉夹层的临床效果.方法 2012年6月至2013年8月,9例小真腔的慢性Stanford A型主动脉夹层患者一期行孙氏手术及升主动脉-股动脉转流术治疗.患者均为男性,年龄27～45岁,平均35.2岁.手术均采用深低温停循环、选择性脑灌注技术.其中行升主动脉替换加孙氏手术5例;Bentall加孙氏手术4例.术中均采用直径较小的24 mm上海微创术中支架,体外循环停机后上、下肢脉压差均大于40mmHg（1 mmHg =0.133 kPa）,患者尿量减少,遂一期行升主动脉-股动脉转流术.结果 患者体外循环（161.0±45.0） min,选择性脑灌注（32.3±8.5） min.一期行升主动脉-股动脉转流术后上、下肢脉压差明显缩小,患者尿量增多.结论 小真腔的慢性Stanford A型主动脉夹层行孙氏手术,术中因真腔较小,置入的术中支架直径较小,易出现下半身缺血,一期行升主动脉-股动脉转流术后常可获得满意的临床疗效.

Objective To explore the treatment of Stanford type A aortic dissection with small true lumen with Sun＇s procedure and ascending aorta-femoral artery bypass at the same time.Methods From June 2012 to August 2013,Sun＇s procedure and ascending aorta-femoral artery bypass was performed in 9 patients with Stanford type A aortic dissection with small true lumen.All patients are males with a mean age 35.2 years（range from 27 to 45 years）.The deep hypothermic circulatory arrest was routinely used for cardiopulmonary bypass.Cerebral protection was achieved by unilateral antegrade brain perfusion.The Sun＇s procedure was performed in all patients,conconitant procedure include ascending aorta replacement in 5 patients,aortic root replacement（Bentall procedure）in 4 patients.The diameter of stent used in operation was 24 mm.After cardiopulmonary bypass the blood pressure of upper limb in all the patients was more than 40 mmHg（5.32 kPa） higher than that of lower limb.And urine volume decreased.Then the bypass from ascending aorta to femoral artery was performed.Results Mean cardiopulmonary bypass time was（161.0 ± 45.0） min.And selected cerebral perfusion time was（32.3 ± 8.5） min.The blood pressure difference between upper limb and lower limb apparently decreased.And urine volume increased.Conclusion Because of small stent used in operation,the patients of Stanford type A aortic dissection with small true lumen could suffer from dysfunction of lower limb.The bypass from ascending aorta to femoral artery is an effective treatment at this time.