保留头臂血管的主动脉弓成形加支架象鼻手术治疗Stanford A型主动脉夹层

目的：探讨保留头臂血管的主动脉弓成形加支架象鼻术治疗Stanford A型主动脉夹层的临床效果。方法采用保留头臂血管的主动脉弓成形加支架象鼻手术治疗23例主动脉夹层Stanford A型的患者，72 h内手术20例，3~14 d内手术3例。结果本组病例住院期间无死亡。全组体外循环时间（209±52）min，升主动脉阻断时间（85±21）min，选择性脑灌注时间为（28±15）min，24 h平均胸引流量为（570±263）mL，术中平均输红细胞悬液量（5.5±3.8）单位，无再次开胸止血病例。23例患者中术后并发急性肾衰竭3例，短暂的神经系统并发症(延迟苏醒)2例，一过性截瘫1例，败血症l例。无永久性神经系统并发症及脏器缺血并发症发生。术后随访6-18个月，均无临床不良事件发生。结论保留头臂血管的主动脉弓成形加支架象鼻术是一种可以选择的主动脉弓部置换的方法，具有安全可行、容易控制出血、简单易于推广的优点。

Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for Stanford type A aortic dissection:analysis of 23 cases

Objective To assess the clinical outcomes of brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique for treatment of Stanford type A aortic dissection. Methods Twenty-three patients with Stanford type A aortic dissection requiring arch replacement underwent brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique. The operations were performed within 72 h (20 cases) or 3-14 days (3 cases) after the onset of aortic dissection. Results There was no perioperative death in these cases. The mean extracorporeal circulation time was 209±52 min, the aortic cross clamp time was 85±21 min, and the mean chest tube output within the first 24 h after the operation was 570 ± 263 mL; none of the patients required chest reopening for management of bleeding. Postoperative acute renal failure requiring hemodialysis occurred in 3 cases, transient neurologic dysfunction in 2 cases, paraplegia in case and hematosepsis in 1 case. No such complications as permanent neurologic deficit or postoperative visceral malperfusion occurred in these cases. All the patients survived and were discharged from hospital without experiencing severe complications in the follow-up for 6-18 months. Conclusion Brachiocephalic artery-sparing aortic arch repair combined with stent-graft elephant trunk technique is a safe and simple procedure with controllable bleeding and can serve as an optional procedure for aortic arch replacement.