两种术式治疗Stanford A型主动脉夹层的病例对照研究

Different surgical procedures for Stanford type A aortic dissection: A case control study

目的分析孙氏手术与去分支复合手术两种不同术式治疗Stanford A型主动脉夹层采的近、中期疗效。方法回顾性分析2014年9月至2017年9月我院确诊为Stanford A型主动脉夹层行外科手术治疗46例患者的临床资料,其中男39例、女7例,年龄20~74(48.67±11.80)岁。据手术方式将患者分为孙氏手术组(26例)和去分支复合手术组(20例),比较两组临床结果。结果去分支复合手术组在体外循环(cardiopulmonary bypass time,CPB)时间、主动脉阻断(aortic cross clamp,ACC)时间、术中尿量、术后呼吸机辅助呼吸时间、术后24h引流液量、监护病房停留时间较孙氏手术组有明显优势(P<0.05)。术后暂时性神经系统功能损害发生率低于孙氏手术组(P<0.05)。术后随访时间3~36个月,随访率为90.5%。孙氏手术组1例术后30d死于肺部严重感染,去分支复合手术组1例患者在术后早期复查时发现内漏,6个月后复查时内漏消失。孙氏手术组未出现内漏。随访期间所有患者均未出现脑卒中、凝血功能障碍、截瘫、上肢缺血等并发症。结论对于StanfordA型主动脉夹层,去分支复合手术虽然有术后发生内漏风险,但整体疗效较之孙氏手术有一定优越性,故而对于此型夹层的治疗可优先选择去分支复合手术。

Objective To analyze the near-term clinical efficacy of two different surgical procedures (Sun's procedure and Debranching combined endovascular stent-graft procedure) to cure Stanford type A aortic dissection, and summarize the clinical experience to help better master the indications of the two surgical procedures. Methods We retrospectively analyzed the clinical data of 46 patients with Stanford A aortic dissection in our hospital between September 2014 and September 2017. There were 39 males and 7 females at age of 20–74 (48.67±11.80) years. According to different surgical methods, the patients were divided into a Sun's procedure group (26 patients) and a debranching combined endovascular stent-graft procedure group (20 patients). The clinical effect of the two groups was compared. Results The debranching combined endovascular stent-graft procedure group was significantly superior to the Sun's group in cardiopulmonary bypass (CPB) time, aortic cross clamp(ACC) time, intraoperative urine output, postoperative mechanical ventilation time, postoperative 24 h volumes of drain, CICU time, renal function recovery of postoperative 72 h and total hospital stay(P<0.05). The incidence of transient neurological damage after operation in the debranching combined endovascular stent-graft procedure group was significantly lower than that of the Sun's procedure group(P<0.05). The follow-up time ranged from 3 to 36 months. And the follow-up rate was 90.5%. One patient in the Sun's procedure group died of serious pulmonary infection postoperative 30 days. One patient in the debranching combined endovascular stent-graft group was found to have internal leakage in the early postoperative examination and disappeared after 6 months. Sun's procedure group did not find endoleak. All patients during the follow-up time did not appear brain, coagulation disorders, stroke, paraplegia, upper limb ischemia and other complications. Conclusion For Stanford type A aortic dissection, debranching combined surgery may have the risk of postoperative endoleak, but the overall effect is superior to Sun's operation. Therefore, debranching combined surgery should be preferred for the treatment of this type of dissection.