高龄Stanford A型主动脉夹层外科治疗临床分析

Surgical treatment of type A aortic dissection in elderly patients

目的总结高龄Stanford A型主动脉夹层患者外科治疗的临床效果。方法自2016年8月至2018年8月我中心共收治≥60岁Stanford A型主动脉夹层行外科手术患者139例,男90例(64.7%),女49例(35.3%);年龄(65.1±3.8)岁,最高龄者80岁。所有患者均完善必要的术前检查,急诊手术123例(88.5%),限期手术16例(11.5%);累及弓部的手术均在深低温停循环+选择性脑灌注下完成;根部手术方式分为Bentall手术、Wheat手术、David手术和单纯升主动脉替换,弓部手术方式分为部分主动脉弓替换术、经典孙氏手术、改良孙氏手术(岛状吻合);术后根据上下肢测压(压差≥40 mmHg,5.33 kPa)决定是否行人工血管旁路转流术;合并的其他心脏病变同期处理。结果围术期死亡7例(5.0%),多脏器功能衰竭5例(3.6%),呼吸功能衰竭和心功能衰竭各1例(0.7%)。术后严重并发症为急性肾损伤19例(13.7%),低氧血症17例(12.2%),中枢神经系统并发症15例(10.8%)。结论外科手术仍是高龄主动脉夹层患者治疗的首选;个体化的外科治疗安全有效。

Objective To analyze the clinical efficacy of surgical treatment of elderly patients with type A aortic dissection(TAAD).Methods A retrospective study including 139 elderly patients(age≥60 years)with TAAD between August 2016 to August 2018 in Beijing Anzhen Hospital was performed.There were 90 male patients(64.7%)and 49 female patients(35.3%),aged 60-80(65.1±3.8)years.All patients completed the necessary preoperative examination,123 patients underwent emergency surgery and the other 16 patients underwent elective surgery.Deep hypothermia circulatory arrest(DHCA)and selective cerebral perfusion(SCP)were used in arch surgery.The root surgery was divided into Bentall,Wheat,David and ascending aorta replacement and the arch surgery was divided into partial aortic arch replacement,classic Sun's procedure,and modified Sun's procedure.Bypass surgery was done when pressure difference(≥40 mmHg,5.33 kPa)between upper and lower extremities existed.Other combined heart diseases were treated at the same time.Results Operative mortality rate was 5.0%(7 cases),5 case(3.6%)with multiple organ dystuaction syndrome,1 case(0.7%)with respiratory failure and 1 case(0.7%)with heart failure.The postoperative complications were hypoxemia(12.2%),neurological complications(10.8%),acute kidney injury(13.7%).Conclusion Surgical treatment is the first choice for aged patients with TAAD and individualized treatment is safe and effective.