杂交全主动脉弓修复术与全主动脉弓置换结合支架象鼻置入术治疗急性主动脉夹层的对比研究

Comparative Study on Hybrid Total Aortic Arch Repair and Total Aortic Arch Replacement Combined with Stented Elephant Trunk Implantation in the Treatment of Acute Aortic Dissection

目的比较杂交全主动脉弓修复术与全主动脉弓置换结合支架象鼻置入术治疗急性主动脉夹层(AAD)的临床效果。方法选取2019年7月至2021年2月我院收治的98例AAD患者,按手术方式不同分为A组(50例)和B组(48例)。A组接受杂交全主动脉弓修复术治疗,B组接受全主动脉弓置换结合支架象鼻置入术治疗,比较两组患者的术中指标、术后状态、围术期死亡率、并发症发生率及二次开胸率。结果A组手术时的体外循环时间、主动脉阻断时间均短于B组,术中用血量少于B组(P<0.05)。两组患者的手术时间、呼吸机辅助时间、清醒时间、清醒后VAS评分、围术期死亡率、并发症发生率及二次开胸率比较无统计学差异(P>0.05)。结论与全主动脉弓置换结合支架象鼻置入术相比,杂交全主动脉弓修复术治疗AAD患者创伤较小,但两者在近期手术效果方面无明显差异,需根据患者的个体情况选择合适术式。

Objective To compare the clinical effect of hybrid total aortic arch repair and total aortic arch replacement combined with stented elephant trunk implantation in the treatment of acute aortic dissection(AAD).Methods 98 AAD patients admitted to our hospital from July 2019 to February 2021 were selected and divided into group A(50 cases)and group B(48 cases)according to different surgical methods.Group A received hybrid total aortic arch repair,and group B received total aortic arch replacement combined with stented elephant trunk implantation.The intraoperative indicators,postoperative status,perioperative mortality,incidence of complications,and secondary thoracotomy rate in both groups were compared.Results The cardiopulmonary bypass time and aortic occlusion time in group A were shorter than those in group B,and the intraoperative blood consumption was less than that in group B(P<0.05).No statistical difference was found in the operation time,ventilator-assisted time,awakening time,VAS score after awakening,perioperative mortality,incidence of complications,and secondary thoracotomy rate between the two groups(P>0.05).Conclusions Compared with total aortic arch replacement combined with stented elephant trunk implantation,hybrid total aortic arch repair has less trauma in the treatment of AAD patients.No significant difference in the short-term operation effect between the two methods.The appropriate surgical method should be selected according to the individual conditions of patients.