Bentall手术+孙氏手术治疗42例StanfordA3型主动脉夹层的疗效

Clinical effect of Bentall+Sun's operation in 42 patients with Stanford A3 aortic dissection

目的 讨论分析深圳孙逸仙心血管医院行Bentall+孙氏手术治疗急性Stanford A3型主动脉夹层的临床疗效.方法 对2016年9月至2018年12月深圳市孙逸仙心血管医院心血管外科连续收治的42例急性Stanford A3型主动脉夹层手术患者病历资料进行回顾性分析,其中男性36例、女性6例;年龄22~67岁,平均(41.36±12.23)岁.急诊手术30例(71.4%,30/42),择期手术12例(28.6%,12/42),术式均为Bentall+孙氏手术.结果 本组病例手术时间(605.12±98.16)min,体外循环时间(231.79±37.52)min,升主动脉阻断时间(133.62±27.91)min,停循环时间(19.98±7.29)min.住院时间(26.26±11.11)d,ICU停留时间(12.05±3.77)d.术后早期死亡6例(14.2%,6/42).术后并发症19人次(45.2%,19/42),其中7人术后合并多种并发症.包括二次开胸探查3例(9.5%,3/42);神经系统并发症11例(26.2%,11/42);急性肾损伤(AKI)6例(14.3%,6/42);急性肝损伤(AHI)3例(7.1%,3/42);消化道出血2例(4.8%,2/42);术后肺部感染5例(11.9%,5/42).以上并发症除2例脑出血患者转外院治疗,均于出院前治愈.结论 ①对于急性Stanford A3型主动脉夹层,早期行Bentall+孙氏手术治疗方法较为成熟,疗效可;②深低温停循环、选择性脑灌注可提供确切脑保护,但术后仍会发生一定比例的神经系统并发症.

Objective To investigate the clinical effect of Bentall + Sun’s operation on acute Stanford A3 aortic dissection. Methods The clinical data of 42 consecutive patients with acute Stanford A3 aortic dissection admitted to Shenzhen Sun Yat-sen Cardiovascular Hospital from September 2016 to December 2018 were retrospectively reviewed, including 36 males and 6 females, aged 22-67 years, with an average of(41.36±12.23) years. Emergency operation was performed in 30 cases (71.4%, 30/42 ), and selective operation in 12 cases (28.6%, 12 /4 2 ). All operations were Bentall + Sun's operation. Results The operation time, cardiopulmonary bypass tim e, ascending aorta occlusion time and circulatory arrest time were (605.12±98.16) min,(231.79± 37.52)m in,(133.62±27.91) min and (19.98±7.29)m in respectively. The hospitalization time w as(26.26±11.11) days and the ICU stay time was ( 12.05±3.77) days. There were 6 early death cases (14.2%,6 /4 2 ). Postoperative complications occurred in 19 cases (45.2%, 1 9 /4 2 ), of which 7 cases were complicated with multiple complications. 11 cases of neurological complication (26.2%, 11/42), 6 cases o f AKI( 14.3%, 6 /4 2 ), 3 cases of acute liver injury (A HI)(7.1%, 3 /4 2 ), 2 cases of gastrointestinal hemorrhage (4.8%, 2/42 ) and 5 cases of pulmonary infection after operation (11.9%,5 /42). All the above complications were cured before discharge except 2 patients with cerebral hemorrhage who were transferred to other hospital for treatment. Conclusion (1) Early Bentall + Sun's operation is more mature and effective for acute Stanford A3 aortic dissection.(2) Deep hypothermic circulatory arrest and selective cerebral perfusion can provide definite brain protection but there are still a certain proportion of neurological complications after operation.