保留主动脉根部及升主动脉后壁的新术式在急性Stanford A型主动脉夹层中的应用及早期临床效果分析

Application and early clinical effect analysis of A new surgical procedure that preserves the aortic root and posterior wall of the ascending aorta in acute Stanford Type A aortic dissection

目的:总结保留主动脉根部及升主动脉后壁的新术式治疗急性Stanford A型主动脉夹层的手术效果,并对早期临床效果进行分析。方法:回顾性分析2021年1月至2022年6月,新乡医学院第三附属医院及商丘市第一人民医院接受保留主动脉根部及升主动脉后壁的新术式治疗的28例急性Stanford A型主动脉夹层患者的临床资料,其中男20例,女8例,年龄30~74岁。患者夹层均未累及升主动脉后壁,所有患者均采用深低温体外循环下行保留主动脉根部及升主动脉后壁的外科新术式。结果:全组28例患者手术顺利,其中25例痊愈出院,2例术后因心包填塞死亡(死亡率7.1%),1例术后因多器官衰竭自动放弃出院,术后随访22例,患者生命质量均较好,复查胸腹联合CTA均未发生内漏及再发夹层现象,术后主动脉瓣均无中到重度反流。结论:应用保留主动脉根部及升主动脉后壁的外科新术式治疗急性Stanford A型主动脉夹层可以缩短手术时间、降低死亡率、简化手术方式等,具有较好的近期临床疗效,远期临床效果仍需要大量样本的跟踪及随访。

Objective:To summarize the surgical results of acute Stanford type A aortic dissection with the preservation of the aortic root and posterior wall of the ascending aorta,and to analyze the early clinical results.Methods:A retrospective analysis was performed on the clinical data of 28 patients with acute Stanford type A aortic dissection,including 20 males and 8 females aged 30-74 years,who received the new surgical treatment with retaining the aortic root and ascending aortic posterior wall in the Third Affiliated Hospital of Xinxiang Medical College and the First People’s Hospital of Shangqiu city from January 2021 to June 2022.Dissection did not involve the posterior wall of the ascending aorta in all patients,and all patients were treated with a new surgical method of preserving the aortic root and posterior wall of the ascending aorta under deep hypothermia cardiopulmonary bypass.Results:Full set of 28 cases with operation smoothly,including 25 cases recovered discharge,2 cases of postoperative death from cardiac tamponade(mortality 7.1%),1 case postoperatively due to multiple organ failure automatically give up out of the hospital,22 cases of postoperative follow-up,better quality of life of patients,review has not been chest combination CTA of leakage and hairpin layer phenomenon,again in the aortic valve had no postoperative to severe reflux.Conclusions:The application of the new surgical method of preserving the aortic root and posterior wall of the ascending aorta in the treatment of acute Stanford type A aortic dissection can shorten the operation time,reduce the mortality,simplify the surgical method,etc.,and has A good short-term clinical effect,but the longterm clinical effect still needs to be followed up by A large number of samples.