天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (8): 951-954.doi: 10.11958/20150247

• 专题研究-心血管 • 上一篇    下一篇

孙氏手术与三分支主动脉弓覆膜支架治疗Stanford A 型主动脉夹层的效果比较

程凤1， 陈庆良2△， 姜楠2， 陈彤云2， 赵丰2   

  1. 1天津医科大学 （邮编300070）； 2天津市胸科医院
  • 收稿日期:2015-10-20 修回日期:2016-02-05 出版日期:2016-08-15 发布日期:2016-08-22
  • 通讯作者: 陈庆良 E-mail： woshidachengzi@Foxmail.com E-mail:qingliang1971@126.com
  • 作者简介:程凤 （1988）， 女， 硕士在读， 主要从事胸心血管外科研究
  • 基金资助:
    基金项目： 天津市卫生局科技基金项目 （11KG122）

A comparison of Sun’ s operation and ascending aorta replacement combined with open placement of triple-branched stent graft in treatment of type A aortic dissection

CHENG Feng1 ， CHEN Qingliang2△， JIANG Nan2 ， CHEN Tongyun2 ， ZHAO Feng2   

  1. 1 Tianjin Medical University, Tianjin 300070, China; 2 Tianjin Chest Hospital
  • Received:2015-10-20 Revised:2016-02-05 Published:2016-08-15 Online:2016-08-22
  • Contact: CHEN Qingliang E-mail： woshidachengzi@Foxmail.com E-mail:qingliang1971@126.com

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摘要： 摘要： 目的 比较孙氏手术与三分支主动脉弓覆膜支架手术在治疗主动脉夹层方面的临床效果。方法 33 例 Stanford A 型主动脉夹层患者按手术方式分为孙氏手术组 （孙氏组） 22 例和三分支主动脉弓覆膜支架手术组 （三分叉组） 11 例。术前均进行心脏超声， 主动脉计算机断层血管成像 （CTA）， 肝、 肾功能， 血常规等检查， 术中监测体外循环相关指标及术中失血量等， 围手术期监测肝、 肾功能及并发症等情况。出院后通过回访评价患者生存及康复情况。结果 孙氏组围手术期死亡 6 例， 三分叉组围手术期死亡 3 例； 术中出血量三分叉组明显多于孙氏组 ［（3 586.4 ± 2 926.8） mL vs.（2 630.5 ± 1 821.2） mL］； 孙氏组术后左心室舒张末期内径 （LVEDd） 及升主动脉最大内径均低于术前［（50.9±6.9） mm vs.（55.0±7.5） mm，（28.2±1.6） mm vs.（48.8±11.0） mm］， 左心室射血分数 （LVEF） 高于术前 （0.620± 0.031 vs. 0.469±0.104）； 三分叉组术后升主动脉最大内径小于术前 ［（28.6±3.9） mm vs.（50.9±9.2） mm］， 其他指标术前术后比较差异无统计学意义 （P＞0.05）； Kaplan-Meier 生存曲线分析显示 2 组 5 年生存率相似 （Log-rank χ2 =0.095， P＞0.05）； 2 组远期新发夹层、 脑梗死等并发症发生率差异无统计学意义 （P＞0.05）。结论 孙氏手术在降低术中出血量、 改善远期心功能方面相对三分叉手术效果更好， 生存率及远期预后尚需进一步研究。

关键词: 主动脉疾病, 手术, 治疗结果, 孙氏手术, 三分支主动脉弓覆膜支架手术, 主动脉夹层

Abstract: Abstract: Objective To evaluate results of surgical treatment for patients with acute type A aortic dissection using Sun’ s operation and triple-branched stent graft. Methods According to the operation mode, thirty-three patients with type A aortic dissection were divided into Sun’ s operation group (n=22) and triple branches aortic arch stent-graft placement op⁃ eration (triple- branched) group (n=11). Preoperative examinations included cardiac ultrasound, aortic CT angiography (CTA), hepatic and renal functions and blood routine test in all patients. Intraoperative monitoring included the index about cardiopulmonary bypass and blood loss. The perioperative hepatic and renal functions and complications were also recorded. Survival and recovery rates were evaluated by follow-up between two groups of patients. Results There were six periopera⁃ tive death in Sun’ s group, and three patients died in triple-branched group. In triple-branched group, the intraoperative blood loss was significantly increased than that in Sun’ s group [(3 586.4±2 926.8) mL vs. (2 630.5±1 821.2) mL, P＜0.05]. Postoperative echocardiographic examinations revealed that the left ventricular size (LVEDd) and the aortic diameter were decreased while the left ventricular ejection fraction (LVEF) was elevated after surgery in Sun’ s group [(50.9±6.9) mm vs. (55.0±7.5) mm， (28.2±1.6) mm vs. (48.8±11.0) mm, 0.620±0.031 vs. 0.469±0.104, P＜0.05]. Whereas, only the aortic diame⁃ ter was decreased after surgery in triple-branched group [(28.6±3.9) mm vs. (50.9±9.2) mm, P＜0.05]. Kaplan-Meier surviv⁃ al curve showed that five-year survival rate of Sun’ s group was similar with that of triple-branched group (Log-rank χ2 = 0.095， P＞0.05). At 5 year after operation, there were no significant differences in the recurrence of new aortic dissection, the incidence of cerebral infarction and mortality between Sun’ s group and triple-branched group (P＞0.05). Conclusion Sun’ s operation can significantly decrease patient’ s intraoperative blood loss and improve cardiac function. But its survival rate and long term results need advanced observation.

Key words:  aortic diseases, operation, treatment outcome, Sun&rsquo, s operation, open placement of triple-branched stent graft, aortic dissection