孙氏手术治疗A型主动脉夹层的临床分析

Clinical analysis of Sun’s operation for type A aortic dissection

目的探讨孙氏手术治疗A型主动脉夹层(Type A aortic dissection,TAAD)的临床效果。方法回顾性分析2014年5月至2018年7月于重庆医科大学附属第一医院胸外科心脏/大血管外科实施全主动脉弓置换加支架象鼻术(孙氏手术)的60例A型主动脉夹层患者。所有患者均经电子计算机断层扫描血管造影(Computed photograph angiography,CTA)确诊为TAAD,均采用低温停循环联合脑灌注脑保护,最终实施孙氏手术,根据主动脉根部情况,行单纯升主动脉置换、Bentall或David手术。结果60例患者均手术成功,全组体外循环时间(270±68)min,主动脉阻断时间(162±43)min,脑灌注时间(41±14)min,住院期间死亡7例,3例死于术后出血,3例死于术后多器官功能衰竭,1例死于恶性心律失常;术后并发肺部感染4例,胸骨哆开3例,脓毒血症3例,术后脑卒中1例,乳糜胸1例,声带麻痹1例,急性肾功能不全经透析治疗5例,二次手术5例。出院后30 d无死亡病例,行血管内腔内隔绝2例。结论孙氏手术是治疗广泛撕裂的TAAD的安全有效的方法,根据病情选择恰当的外科处理近期治疗效果令人满意。

Objective To evaluate results of surgical treatment for patients with acute type A aortic dissection using Sun's operation.Methods A retrospective analysis was made on 60 patients with type A aortic dissection(TAAD)who underwent total aortic arch replacement and the frozen elephant trunk technique(Sun's operation)in the department of Cardiothoracic Surgery,First Affiliated Hospital of Chongqing Medical University from May 2014 to July 2018.All patients were diagnosed as TAAD by CTA.All patients were treated with hypothermic circulatory arrest combined with cerebral perfusion protection.Finally,Sun's operation was performed.According to the condition of aortic root,simple ascending aorta replacement,Bentall or David's operation were performed.Results All 60 patients were operated successfully.The whole group had extracorporeal circulation time(270±68)min,aortic blockade time(162±43)min,cerebral perfusion time(41±14)min.Seven patients died during hospitalization,three died of postoperative hemorrhage,three died of postoperative multiple organ failure,and one died of malignant arrhythmia.Postoperative complications included 4 cases of pulmonary infection,3 cases of sternotomy and 3 cases of sepsis.There were 1 case of stroke,1 case of chylothorax,1 case of vocal cord paralysis,5 cases of acute renal insufficiency treated by dialysis and 5 cases of secondary operation.No death occurred 30 days after discharge.Endovascular isolation was performed in 2 cases.Conclusion Sun's operation is a safe and effective method for the treatment of TAAD with extensive tear.The short-term effect of surgical treatment according to the condition is satisfactory.