孙氏手术治疗慢性StanfordB型主动脉夹层累及主动脉弓的观察

Experience of Sun＇s procedure for chronic type B dissection with aortic arch involvement

目的总结孙氏手术治疗慢性StanfordB型主动脉夹层累及主动脉弓的临床应用经验。方法本研究为回顾性分析。2009年2月至2015年12月，29例慢性StanfordB型主动脉夹层累及主动脉弓患者在北京安贞医院心脏外科中心接受孙氏手术。男20例，女9例，年龄24～64（41±12）岁。术前合并高血压16例，马方综合征9例，二尖瓣反流3例，冠心病3例，脑血管疾病1例。22例患者合并主动脉弓近端病变，4例患者曾行主动脉根部置换术，2例合并妊娠，4例主动脉弓部畸形。结果1例患者术后大面积脑梗死，转院后在外院死亡。同期手术包括二尖瓣置换术3例，冠状动脉旁路移植术3例，右迷走动脉重建术3例。2例患者术后呼吸机辅助时间超过24h。神经系统并发症2例：术后轻瘫1例，脑梗死1例，经治疗痊愈出院。1例患者因心包积液行心包开窗术，1例因。肾功能衰竭行血液透析，2例患者行气管切开术。随访12～94（43±23）个月，随访中1例患者因二尖瓣瓣周漏再次行二尖瓣置换术，2例行降主动脉腔内覆膜支架植入术，4例患者行胸腹主动脉置换术。结论孙氏手术治疗慢性StanfordB型主动脉夹层累及远端弓，可一期处理主动脉弓部近端病变和远端主动脉夹层病变，获得较满意的近期和远期临床疗效。

Objective To study the surgical treatment of chronic type B dissection with aortic arch involvement using Sun＇s procedure. Methods Between February 2009 and December 2015, 29 patients [20 males, 9 females, with a mean age of （41 ± 12） years, range 24 -64 years] with type B dissection with aortic arch involvement underwent Sun＇s procedure. Sixteen patient had a history of hypertension. Marfan syndrome was observed in 9 cases, coronary artery disease in 3 cases, mitral regurgitation in 3 patients, cerebrovascular disease in one patient. Twenty-two patients suffered proximal aortic arch disease, 4 cases experienced history of aortic root procedure and 2 subjects had history of pregnancy. Four patients had aortic arch malformation. Results One case suffered from massive cerebral infarction after surgery and died in another hospital. Concomitant procedures included mitral valve replacement in 3 cases, coronary artery bypass grafting in 3 patients, reconstruction of the right aberrant subclavian artery in one patient. Ventilator support exceeding 24 hours obseved in 2 patients. One of them recieved continuous renal replacement therapy and recovered before discharge. Spinal cord injury was obseved in one case, brain infarction in one patient and pericardial drainage in one case. Two patients required tracheotomy. During 12-94 （43 ± 23） months＇ follow-up, thoracoabdominal aortic replacment was performed in 4 patients, thoracic endovascular aortic repair （TEVAR） in 2 subjects and repair of perivalvular leakage in one patient.Conclusions Sun＇s procedure obtained satisfactory results in patients with chronic type B dissection with aortic arch involvement. Concomitant repair of proximal aortic arch lesions and distal type B dissection can be adopted using Sun＇s procedure.