Stanford A型主动脉夹层手术中主动脉假腔插管的应用

Application of ascending aortic false lumen cannulation in the operation on Stanford type A aortic dissection

目的:探讨主动脉假腔插管在A型主动脉夹层(AADA)手术中的应用。方法:选自2015年6月到2018年5月,主动脉夹层患者通过主动脉假腔插管建立体外循环进行手术5例,其中4例为辅助股动脉插管灌注,1例为单独升主动脉假腔插管。所有手术均在深低温停循环(DHCA)同时行选择性顺行性脑灌注(ACP)。结果:5例手术均顺利完成,未发生夹层破裂及灌注不足。术后CTA示:升主动脉及主动脉弓部人工血管通畅,术中支架位置良好,无内漏。降主动脉真腔较术前明显扩大,未闭的降主动脉假腔血栓形成。术后2例出现一过性神经功能障碍,表现为术后突然发作的混乱、瞻望或躁动,持续5~10 s,很快缓解。病例3一周后症状完全消失,病例415 d后完全缓解。结论:AADA手术在准备充分并且适应证明确的条件下,经主动脉假腔插管是传统插管的一种有效的替代及补充方案。

Objective: To investigate the application of ascending aortic false lumen cannulation in acute Stanford type A aortic dissection(AADA).Methods: From June 2015 to May 2018,5 patients underwent operations with cardiopulmonary bypass for Stanford type A aortic dissection. One of them perfused through aortic false lumen, another four of them perfused through aortic false lumen together with femoral artery. All 5 cases underwent unilateral selective antegrade cerebral perfusion with deep hypothermic circulatory arrest. Results: All the 5 operations were successfully completed without any dissection rupture or insufficient perfusion. Postoperative CTA showed that the artificial vessels of the ascending aorta and the aortic arch were unobstructed, and the stent was in good position without endoleak. The true lumen of descending aorta was obviously enlarged and the thrombosis was formed in the false lumen of descending aorta which is unclosed. Transient neurological dysfunction occurred in 2 patients after operation, manifested as sudden onset of confusion, prospective or restlessness, lasting for 5-10 seconds, and soon relieved. In Example 3, the symptoms disappeared completely after about one week, and in Example 4, it was completely relieved after about half a month. During the hospitalization, there were transient cerebral ischemia in 2 cases and no deaths cases. Conclusions: In type A aortic dissection, trans-aortic pseudoluminal intubation is an effective alternative and supplement to traditional intubation under well-prepared and well-defined indications.