• 上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院?心血管外科, 上海?200127;

目的 探討Stanford A型急性主動脈夾層累及根部的手術(shù)治療策略?!》椒ā∩虾=煌ù髮W(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院自2005年1月至2010年12月,共62例Stanford A型急性主動脈夾層累及根部的患者接受手術(shù)治療。根據(jù)對夾層近心端采用的不同手術(shù)處理方法分為3組,A組:28例,男20例、女 8例,年齡(45.2±15.6)歲;行主動脈瓣交界懸吊+升主動脈置換術(shù); B組:10例,男7例、女3例,年齡(44.6±14.9)歲;行部分竇部成形+升主動脈置換術(shù); C組:24例,男 17例、女7例,年齡(46.2±15.6)歲;行Bentall手術(shù)。比較分析3組患者的臨床效果?!〗Y(jié)果 圍術(shù)期死亡6例,病死率為9.67% (6/62)。共隨訪54例,隨訪(27.3±15.7) 個月。隨訪期間死亡2例,1例死亡原因不明,1例死于肺癌。A組1例患者術(shù)后6個月復(fù)查CT顯示主動脈竇部假性動脈瘤。C組體外循環(huán)時(shí)間、主動脈阻斷時(shí)間明顯較A組和B組長 [(274±97) min vs. (194±65) min、 (210±77) min,t=22.482, 30.419,P=0.002,0.122; (150±56) min vs. (97±33) min、 (105±46) min, t=12.630,17.089,P=0.000,0.034] 。3組患者的住院死亡率(t=1.352,P=0.516)及圍術(shù)期二次開胸、急性腎損傷、神經(jīng)系統(tǒng)并發(fā)癥發(fā)生情況差異無統(tǒng)計(jì)學(xué)意義(t=0.855,0.342,2.281;P=0.652,0.863,0.320)?!〗Y(jié)論 針對急性主動脈夾層病變累及根部的手術(shù)治療可以采用主動脈瓣交界懸吊+升主動脈置換術(shù)、部分竇部成形+升主動脈置換術(shù)和Bentall手術(shù)等方法,并各有其優(yōu)缺點(diǎn)。掌握每種方法的手術(shù)指征,靈活運(yùn)用,可以獲得滿意的臨床效果。

引用本文: 胡振雷,薛松,徐根興,黃日太,劉沙,連鋒. 急性主動脈夾層累及根部的外科治療. 中國胸心血管外科臨床雜志, 2012, 19(4): 381-384. doi: 復(fù)制

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6.  Suzuki S, Masuda M?. An update on surgery for acute type A aortic dissection: aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39 (4):281-289.
7.  Concistre G, Casali G, Santaniello E, et al. Reoperation after surgical correction of acute type A aortic dissection:risk factor analysis. Ann Thorac Surg, 2012, 93 (2):450-455.
8.  Itoh M, Okazaki Y, Ikeda K, et al. Partial aortic root remodeling for fistula between the non-coronary sinus and the right atrium. Heart Lung Circ, 2008, 17 (3):243-263.
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12.  Van Putte BP, Ozturk S, Siddiqi s, et al. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg, 2012, 93 (2):503-509.
13.  Tanaka M, Kimura N, Yamaguchi A, et al. In-hospital and long-term results of surgery for acute type A aortic dissection:243 consecutive patients. Ann Thorac Cardiovasc Surg, 2012, 18 (1):18-23.
14.  Zizza A, Pano M, Zaccaria S, et al. Outcome of acute type A aortic dissection:single-center experience from 1998 to 2007. J Prev Med Hyg, 2009, 50 (3):152-158.
15.  Borghetti V, Dionisi D, Principi M, et al. Aortic valve re-implantation technique with Gelweave Valsalva prosthesis:safety, reproducibility and pitfalls of a geometric reconstruction. J Cardiovasc Med, 2009, 10 (11):834-841.
16.  Settepani F, Bergonzini M, Barbone A, et al. Reimplantation valve-sparing aortic root replacement with the Valsalva graft:what have we learnt after 100 cases ? Interact Cardiovasc Thorac Surg, 2009, 9 (1):113-116.
17.  Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2012, 41 (1):56-62.
18.   Kallenbach K, Pethig K, Leyh RG, et al. Acute dissection of the ascending aorta: first results of emergency valve sparing aortic root reconstruction. Eur J Cardiothorac Surg, 2002, 22 (2): 218-222.
19.  Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37 (3):691-696.
20.  Kimura N, Tanaka M, Kawahito K, et al. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2008, 136 (5):1160-1166.
21. -633.
22. -1357.
  1. 1.  Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection:Perspectives from the international registry of acute aortic dissection. Eur J Vasc Endovasc Surg, 2009, 37 (2):149-59.
  2. 2.  Moon MR. Approach to the treatment of aortic dissection. Surg Clin North Am, 2009, 89 (4):869-893.
  3. 3.  Rylski B, Suedkamp M, Beyersdorf F, et al. Outcome after surgery for acute aortic dissection type A in patients over 70 years: data analysis from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg, 2011, 40 (2):435-440.
  4. 4.  Kallenbach K, Oelze T, Salcher R, et al. Evolving strategies for treatment of acute aortic dissection type A. Circulation, 2004, 110 (11 Suppl 1):Ⅱ243-249.
  5. 5.  Hata H,Takano H,Matsumiya G,et a1. Late complications of gelatin resorcin formalin glue in the repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 83 (5):1621-1626.
  6. 6.  Suzuki S, Masuda M?. An update on surgery for acute type A aortic dissection: aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39 (4):281-289.
  7. 7.  Concistre G, Casali G, Santaniello E, et al. Reoperation after surgical correction of acute type A aortic dissection:risk factor analysis. Ann Thorac Surg, 2012, 93 (2):450-455.
  8. 8.  Itoh M, Okazaki Y, Ikeda K, et al. Partial aortic root remodeling for fistula between the non-coronary sinus and the right atrium. Heart Lung Circ, 2008, 17 (3):243-263.
  9. 9.  Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aorticdissection. Ann Thorac Surg, 2000, 70 (4): 1227-1233.
  10. 10.  Louis-Mathieu Stevens, Joren C. Madsen, Eric M. Isselbacher, et al. Surgical management and long-term outcomes for acute ascending aortic dissection. J Thorac Cardiovasc Surg, 2009, 138 (6):.
  11. 11.  Halstead JC, Spielvogel D, Dieter MM, et al. Composite aortic root replacement in acute type A dissection:time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27 (4):.
  12. 12.  Van Putte BP, Ozturk S, Siddiqi s, et al. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg, 2012, 93 (2):503-509.
  13. 13.  Tanaka M, Kimura N, Yamaguchi A, et al. In-hospital and long-term results of surgery for acute type A aortic dissection:243 consecutive patients. Ann Thorac Cardiovasc Surg, 2012, 18 (1):18-23.
  14. 14.  Zizza A, Pano M, Zaccaria S, et al. Outcome of acute type A aortic dissection:single-center experience from 1998 to 2007. J Prev Med Hyg, 2009, 50 (3):152-158.
  15. 15.  Borghetti V, Dionisi D, Principi M, et al. Aortic valve re-implantation technique with Gelweave Valsalva prosthesis:safety, reproducibility and pitfalls of a geometric reconstruction. J Cardiovasc Med, 2009, 10 (11):834-841.
  16. 16.  Settepani F, Bergonzini M, Barbone A, et al. Reimplantation valve-sparing aortic root replacement with the Valsalva graft:what have we learnt after 100 cases ? Interact Cardiovasc Thorac Surg, 2009, 9 (1):113-116.
  17. 17.  Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation (David I). Eur J Cardiothorac Surg, 2012, 41 (1):56-62.
  18. 18.   Kallenbach K, Pethig K, Leyh RG, et al. Acute dissection of the ascending aorta: first results of emergency valve sparing aortic root reconstruction. Eur J Cardiothorac Surg, 2002, 22 (2): 218-222.
  19. 19.  Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37 (3):691-696.
  20. 20.  Kimura N, Tanaka M, Kawahito K, et al. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2008, 136 (5):1160-1166.
  21. 21. -633.
  22. 22. -1357.