术中支架系统在主动脉夹层外科手术中的应用

目的 总结术中支架系统在主动脉夹层外科手术中应用的临床经验.方法 1 17例主动脉夹层病人,在深低温停循环下行含术中支架系统直视下置入的手术.Stanford A型50例中行Bentall+全弓+支架象鼻术(CRONUS术中支架系统直视下置入)28例,Wheat+全弓+支架象鼻术8例,升主动脉及全弓置换+支架象鼻术14例.Stanford B型67例均行支架象鼻术.结果 体外循环(159±31)min,主动脉阻断(95±23)min,脑灌注(27±8)min.住院死亡3例.发生一过性脑功能紊乱11例,脑血管意外6例,血管吻合口出血开胸止血5例,声音嘶哑2例,肾功能衰竭1例.术后CT均显示,术中支架系统位置良好,血流通畅,无内漏,降主动脉真腔较术前明显扩大,未闭的降主动脉假腔血栓形成.结论 术中支架系统在主动脉夹层手术中的应用是安全、有效的.其能准确封闭血管内膜破口,实现血管壁的重建,简化手术,创伤小,并发症少,疗效确切.

The treatment of aortic dissection with stent-graft

Objective To summarise the clinical experience on the treatment of aortic dissection with stent-graft. Methods From June 2005 to November 2008, 117 patients with aortic dissection underwent surgery with stented elephant trunk (CRONUS stent-graft)which was implanted through the aortic arch under deep hypothermic circulatory arrest, including Stanford A in 50 patients who underwent Bentall operation and total arch grafting with stented elephant trunk operation in 28, Wheat operation and total arch grafting with stented elephant trunk operation in 8, ascending aorta and total arch replacement with stented elephant trunk operation in 14 and Stanford B in 67 patients who all underwent stented elephant trunk operation. Results The location of the entry was in the ascending aorta in 35 patients, the aortic arch in 4, the proximal descending aorta in 78. Cardiopulmonary bypass time was ( 159 ±31 ) min, average cross clamp time was (95 ±23) min, and average selected cerebral perfusion and lowerbody arrest time was (27 ±8) min. The in-hospital mortality was 2.6% (3/117). One patient died of the hemorrhage shock, one died of multi-organ failure postoperatively and the third died of infective endocarditis. The complications included transient neurologic deficit in 11(9.4%), cerebrovascular accident in 6 (5. 1%, cerebral embolism in 2 and cerebral hemorrhage in 4, of which 5 cases were discharged from hospital. One case died of multiorgan failure 18 days after discharge owing to his family' s giving up treatment), hemorrhage of anastomose which was treated by reoperation in 5,hoarseness in 2, renal failure in 1. One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during following up. Conclusion The treatment of the aortic dissection with stent-graft which was implanted into the descending aorta through aorta arch is safe, effective and feasible, which will be helpful to vascular reconstruction by accurately close subintimal rip and can streamline surgery with minimally invasive and less complications.