改良支架"象鼻"手术治疗Stanford A型主动脉夹层的临床应用

目的:探讨改良支架"象鼻"手术治疗主动脉夹层的方法和效果.方法:20例Stanford A型主动脉夹层患者,年龄23～71岁,中位年龄50.7岁.其中急性夹层14例,慢性夹层6例.应用深低温停循环(DHCA)和上腔静脉逆行灌注或右腋动脉顺行灌注(SCP)进行脑保护,施行改良支架"象鼻"手术(即升主动脉和半弓置换及降主动脉腔内支架植入).同期行Ben-tall手术11例,Cabrol 2例.停循环时间36～86 min,平均34.5 min.结果:术后住院死亡2例(10%).存活患者获随访3个月～2年,无死亡,其中10例于术后3个月定期行主动脉多层螺旋CT检查,8例降主动脉夹层内有血栓形成,2例有部分血栓形成.结论:改良支架"象鼻"手术简单,停循环时间短,可以达到支架"象鼻"手术的同样效果,远期降主动脉假腔封闭率仍有待进一步的临床随访观察.

Clinical application of modified "elephant trunk" stent-graft in treatment of type Stanford A aortic dissection

Objective:To investigate the procedures and outcomes of modified "elephant trunk" stent-graft technique in the treatment of aortic dissection.Methods: Twenty patients(aged 23-71 years,mean 50.7 years) suffered from type Standford A aortic dissection(acute 14,chronic 6) were included in our study.During deep hypothermic circulatory arrest(DHCA),retrograde cerebral perfusion(RCP) or selected antegrade cerebral perfusion(SCP) was used to protect the brain.All patients received modified "elephant trunk" stent-graft(ascending aorta and semi-arch replacement combined with transluminal stent-graft of the descending aorta).Concomitant operations included 11 Bentall's procedures and 2 Cabrol's procedures.Circulatory arrest time ranged from 36 to 86 min(mean 34.5 min).Results: Two patients died after operation(10%).Survival patients were followed up for 3 to 24 months and no subsequent death occurred during the fellow-up period.Multi-detector row computed tomography angiography of aorta was performed in 10 patients 3 months after surgery.Complete thrombosis of the false lumen in descending aorta was found in 8 cases and partial thrombosis was found in 2 cases.Conclusion: Our modified "elephant trunk" stent-graft is a simple method with short circulatory arrest time.It has a similar outcome as standard "elephant trunk" stent-graft.The long-time false lumen occlusion rate of descending aorta demands further clinical follow-up investigation.