免缝合技术治疗急性A型主动脉夹层

Suture-free technique for acute aortic type A dissection

目的评估孙氏手术应用免缝合人工血管置换技术治疗急性A型主动脉夹层的手术疗效。方法回顾性分析2019年5月至2023年4月40例完成孙氏手术治疗的急性A型主动脉夹层患者资料。根据手术方法分为免缝合组(20例)和传统组(20例),比较两组停循环时间、体外循环时间、苏醒时间、插管时间、术后12h出血量、脑梗塞和急性肾功能衰竭的发生情况。剔除年龄大于70岁、术前合并灌注不良综合征或未行孙氏手术的患者。结果果免缝合组与传统组相比,停循环时间短[(13.6±3.3)min对(28.2±5.6)min,P<0.001],体外循环时间短[(116.0±34.8)min对(219.1±46.3)min,P<0.001],术后12h出血量少[(474.5±301.0)ml对(422.7±389.8)ml,P<0.001]。40例患者均生存,出院。两组苏醒时间、插管时间、脑梗塞和急性肾功能衰竭发生率差异无统计学意义。结论免缝合血管置换技术显著缩短了停循环时间及体外循环时间,有效地保护全身脏器功能,减少术后并发症发生。此技术在基层医院易于开展,是采用孙氏手术治疗急性A型主动脉夹层时安全、有效的新策略。

Objective To evaluate the curative effect of Sun's procedure using sutureless artificial blood vessel replacement technique on acute type A aortic dissection.Methods Retrospective analysis was performed on 40 patients with acute type A aortic dissection who underwent Sun's procedure in The First Peoples Hospital of Nanning from May 2019 to April 2023.According to the surgical method,the patients were divided into sutureless group(20 cases)and traditional group(20 cases).The time of stopping circulation,cardiopulmonary bypass,recovery time,intubation time,blood loss 12 h after operation,cerebral infarction and acute renal failure were compared between the two groups.Patients older than 70 years,patients with preoperative malperfusion syndrome,or patients who did not undergo Suns procedure were excluded.Results The time of stopping circulation[(13.6±3.3)min vs.(28.2±5.6)min,P<0.001]and the time of cardiopulmonary bypass[(116.0±34.8)min vs.(219.1±46.3)min,P<0.001]and blood loss at 12 h after operation[(474.5±301.0)ml vs.(422.7±389.8)ml,P<0.001] in the sutureless group were significantly lower than those in the traditional group.All patients survived and were discharged from hospital.There were no significant differences in recovery time,intubation time,cerebral infarction and acute renal failure between the two groups.Conclusion Sutureless artificial blood vessel replacement technique can significantly shorten the time of stopping circulation and cardiopulmonary bypass,effectively protect the function of the whole body organs,and reduce the occurrence of postoperative complications.Moreover,it is easy to carry out in primary hospitals,and it is a safe and effective new surgical strategy for treating acute type A aortic dissection with Sun's surgery.