支架象鼻开窗简化手术治疗急性StanfordA型主动脉夹层的临床分析

A simplified clinical analysis of surgery in the treatment of acute Stanford type A aortic dissection in the stented elephant trunk fenestration

目的研究支架象鼻开窗简化手术在治疗急性StanfordA型主动脉夹层中的临床效果。方法选取2010年1月至2017年1月于我院就诊的急性StanfordA型主动脉夹层患者78例，按照治疗方法的不同，分为观察组与对照组，各组均为39例。观察组患者采用简化全弓置换加支架象鼻手术进行治疗，对照组患者采用全弓置换术加支架象鼻手术进行治疗，对比两组患者的临床疗效。结果两组患者的手术均顺利完成，手术过程中均无患者死亡。观察组患者的体外循环时间（147±27）min、阻断时间（78±12）min、机械通气时间（12±4）h、ICU停留时间（1．8±0．9）d、住院时间（13±2）d，均显著短于对照组患者[体外循环时间（184±23）min、阻断时间（102±13）min、机械通气时间（20±4）h、ICU停留时间（3．1±0．7）d、住院时间（16±3）d]（P〈0．05）；观察组患者术后并发症发生率2．56％，显著低于对照组15．38％（P〈0．05）。结论采用支架象鼻开窗简化手术治疗急性StanfordA型主动脉夹层，能够缩短患者的体外循环时间、阻断时间、机械通气时间、ICU停留时间，降低术后并发症发生率，近期临床治疗效果较好。

Objective To study the clinical effect of stented elephant trunk fenestration and simplifying the operation in the treatment of acute Stanford type A aortic dissection. Methods 78 cases of acute A type Stan- ford aortic dissection in our hospital from January 2010 to January 2017 were selected and divided into the obser- vation group and the control group according to the different treatment methods. The patients in each group were 39 cases. The observation group were treated by simplified total arch replacement with stented elephant trunk surgery treatment, the control group was treated with total arch replacement with stented elephant trunk surgery treatment, the clinical efficacy of the two groups were compared. Results The two groups of patients were successfully com- pleted surgery, no patient died during the operation. The observation group of patients with cardiopulmonary bypass time （ 147 ±27 ）rain, clamping time （ 78 ± 12 ）rain, mechanical ventilation time （ 12±4）h, ICU stay （ 1.8 ±0.9 ）d and hospital stay（ 13＋2 ）d were significantly shorter than the control group [ cardiopulmonary bypass time（ 184±23 ）min, clamping time（102±13）min, mechanical ventilation time（20±4）h, ICU stay（3.1±0.7）d and hospital stay （16±3）d] （P〈0.05）; postoperative complications of the observation group 2.56% was significantly lower than the control group15.38%（P〈0.05）. Conclusion The simplified stented elephant trunk fenestration operation in the treatment of acute Stanford type A aortic dissection, patients can shorten the CPB time, clamping time, mechanical ventilation time, ICU stay time, reduce the incidence of postoperative complications and recent clinical curative effect is better.