主动脉外膜内翻技术在急性A型主动脉夹层根部手术处理中的应用

Application of aortic adventitia varus technique in root surgical treatment of acute type A aortic dissection

目的 探讨主动脉血管外膜内翻技术在急性A型主动脉夹层(ATAAD)患者根部手术处理中的应用效果。方法 回顾性分析2019年10月至2020年9月在西安交通大学第一附属医院确诊并行升主动脉置换+全弓置换+象鼻支架植入手术治疗的ATAAD患者82例的临床资料。根据主动脉根部不同的处理方式分为A组(试验组,n=37,采用主动脉血管外膜内翻技术)和B组(对照组,n=45,采用常规连续缝合并间断带垫片褥式缝合加固,并利用自身血管外膜或牛心包进行包裹,必要时进行包裹后升主动脉-右房分流)。比较两组患者术后的临床转归。结果 两组患者在术后死亡率、连续肾脏替代治疗(CRRT)使用率、低氧血症发生率等方面差异无统计学意义(P>0.05)。但A组的术中体外循环时间、主动脉阻断时间明显少于B组,差异有统计学意义(P<0.01);A组在围术期红细胞输注量、术后机械通气时间、ICU滞留时间、总住院时间方面均少于B组,差异有统计学意义(P<0.05)。结论 主动脉血管外膜内翻技术应用于ATAAD患者主动脉根部处理安全、有效,可获得满意的疗效。

Objective To investigate the effect of aortic adventitia varus technique in root surgical treatment of patients with acute type A aortic dissection(ATAAD). Methods The clinical data of 82 patients with ATAAD diagnosed and treated with ascending aorta replacement + total arch replacement + elephant trunk stent implantation in the First Affiliated Hospital of Xi’an Jiaotong University from October 2019 to September 2020 were analyzed retrospectively. According to different treatment methods of aortic root, they were divided into group A(experimental group, n=37, aortic root was treated with aortic adventitia varus technique) and group B(control group, n=45, the aortic root was treated with conventional continuous suture and intermittent mattress suture reinforcement with gasket, and wrapped with its own vascular adventitia or bovine pericardium, the ascending aorta-right atrial shunt was performed after wrapping if necessary). The postoperative clinical outcomes of the two groups were analyzed and compared. Results There was no significant difference in postoperative mortality, CRRT use rate and incidence of hypoxemia between the two groups(P>0.05). However, the intraoperative cardiopulmonary bypass time and aortic occlusion time in group A were significantly shorter than those in group B(P<0.01). The perioperative erythrocyte infusion volume, postoperative mechanical ventilation time, ICU stay time and total hospital stay in group A were less than those in group B(P<0.05). Conclusion The application of aortic adventitia varus technique in aortic root treatment of ATAAD patients is safe and effective, and can obtain satisfactory curative effect.