去分支杂交手术治疗60岁以上急性Stanford A型夹层患者近中期疗效分析

Short and mid-term curative effect of hybrid aortic arch debranching surgery in patients over 60 years with acute stanford A aortic dissection

目的探讨主动脉弓去分支杂交技术治疗60岁以上急性Stanford A型主动脉夹层患者的近中期疗效。方法分析2018年1月至2020年12月郑州大学第一附属医院收治并行手术治疗的60岁以上急性Stanford A型主动脉夹层患者共89例,其中男32例,女57例,其中行杂交手术患者41例,行孙氏手术患者48例,比较两组患者结果。结果去分支杂交手术组手术时间[(5.87±1.77)h比(8.31±1.67)h]以及体外循环时间[(114.31±23.45)min比(257.66±54.63)min]显著低于孙氏手术组,差异有统计学意义(t=15.830、19.510,P<0.05);去分支杂交手术组术后肾功能不全发生率[7.3%(3/41)]显著低于孙氏手术组[29.2%(14/48)],差异有统计学意义(χ2=6.832,P<0.05);去分支杂交手术组术后严重肺部感染发生率[4.9%(2/41)]显著低于孙氏手术组[22.9%(11/48)],差异有统计学意义(χ2=5.769,P<0.05);去分支杂交手术组左侧锁骨下动脉重建率[100%(41/41)]显著高于孙氏手术组[68.8%(33/48)],差异有统计学意义(χ2=17.823,P<0.05)。两组患者住院期间死亡率[14.6%(6/41)比22.9%(9/48)]的差异无统计学意义(χ2=0.267,P>0.05)。两组患者其他术后早期并发症如二次开胸、肝功能不全、内漏、CRRT、脑梗、截瘫的发生率差异无统计学意义(χ2=0.653、0.827、2.395、2.238、0.717、0.530,P>0.05)。K-M生存分析显示,杂交手术组与孙氏手术组在早-中期生存率的比较差异无统计学意义(P>0.05)。结论去分支杂交手术治疗60岁以上Stanford A型主动脉夹层患者疗效显著,并发症少,左锁骨下动脉重建成功率高。

Objective To observe the early and mid-term outcomes and the incidence of adverse events in elderly patients with acute stanford A aortic dissection after undergoing hybrid aortic arch debranching surgery.Methods We analyzed the clinical data of 89 patients aged over 60 years with acute Stanford A aortic dissection having undergone surgery in our hospital,including 32 males and 57 females.According to the type of procedure,the patients were divided into two groups:the hybrid aortic arch debranching surgery group(n=41),and the Sun’s procedure group(n=48).We compared the clinical results perioperation between the two groups,patients were followed up for 2 years,and the prognosis of the two types of operations were observed.SPSS 26.0 software was used to statistically analyze and compare the results of the two groups.Results:The operation time[(5.87±1.77)h vs.(8.31±1.67)h]and the extracorporeal circulation time[(114.31±23.45)min vs.(257.66±54.63)min]in the branch-free hybrid surgery group were significantly shorter than those in the Sun’s surgery group(t=15.830,19.510,P<0.05).The incidence of postoperative renal insufficiency[7.3%(3/41)]in the debranching hybrid operation group was significantly lower than that in the Sun’s operation group[29.2%(14/48)](χ2=6.832,P<0.05).The incidence of severe pulmonary infection in the debranching hybrid operation group[4.9%(2/41)]was significantly lower than that in the Sun’s operation group[22.9%(11/48)](χ2=5.769,P<0.05).The left subclavian artery reconstruction rate[100%(41/41)]in the debranching hybrid operation group was significantly higher than that in Sun’s operation group[68.8%(33/48)](χ2=17.823,P>0.05).There was no significant difference in the in-hospital mortality between the two groups[14.6%(6/41)vs.22.9%(9/48),χ2=0.267,P>0.05].There was no significant difference in the incidence of other early postoperative complications between the two groups,such as secondary thoracotomy,hepatic insufficiency,endoleak,CRRT,cerebral infarction,and paraplegia(χ2=0.653,0.827,2.395,2.238,0.717,0.530,P>0.05).K–M survival analysis showed that there was no significant difference between the hybrid surgery group and Sun’s surgery group in the early-to-mid-term survival rate(P>0.05).Conclusion Debranching hybrid surgery has a significant curative effect on patients over 60 years old with Stanford type A aortic dissection,with fewer complications and a high success rate of left subclavian artery reconstruction.