直视下补片修补急性A型胸主动脉夹层合并的降主动脉内膜破口

目的:探讨合并降主动脉内膜破口的A型胸主动脉夹层的手术新方法.方法:3例急性A型胸主动脉夹层患者在深低温停循环、经上腔静脉逆灌下行升主动脉和半弓置换,同时直视下探查降主动脉近端的内膜破口.用卵圆形毛毡片分别置于裂口处内膜的外侧和内侧,用4-0丙烯线作连续缝合修补破口.结果:3例患者均顺利出院.术后2～3个月行螺旋CT结果显示:3例患者胸部降主动脉夹层均已形成血栓;其中2例假腔消失,另1例假腔明显缩小,但仍有少量血流与真腔相通,可能为降主动脉内膜破口修补处渗漏.结论:对同时合并有降主动脉内膜破口的A型胸主动脉夹层患者行降主动脉内膜破裂口修补具有良好的临床效果,避免了二期降主动脉手术.

Repair of intimal tear in descending aorta with felt patches in patients with acute type A dissection

Objective:To report a new surgical technique for treatment of type A dissection with intimal tears in the descending aorta.Methods: Three patients with acute type A dissection received ascending aorta and hemiarch replacement under deep hypothermic circulatory arrest and retrograde cerebral perfusion. Meanwhile,the intimal tear in the descending aorta were inspected. The oval-shaped Teflon felt patches were put both inside and outside of the intimal tear and continuous sutures were fulfilled to close the tear with 4-0 prolene. Results: All the 3 patients recovered and were discharged from hospital uneventfully.Follow-up after 2-3 months showed that thrombosis formed in the dissected descending aorta in all the 3 patients. The false lumen disappeared in 2 cases, and was obviously retracted in the remaining case (still with slight blood stream passing between true and false lumens), probably due to leakage of the tear repair.Conclusion: Intimal repair is an effective method for Type A dissection patients with intimal tears in the descending aorta,avoiding second stage operarions.