[1]朱贵军 陈兴澎**.急性A型主动脉夹层根部的个体化治疗与精准外科操作策略[J].中国微创外科杂志,2023,01(8):561-566.
　Zhu Guijun,Chen Xingpeng..Individualized Treatment and Precise Surgical Strategies for the Root of Acute Type A Aortic Dissection[J].Chinese Journal of Minimally Invasive Surgery,2023,01(8):561-566.
点击复制

急性A型主动脉夹层根部的个体化治疗与精准外科操作策略()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年8期
页码:
561-566
栏目:
临床研究
出版日期:
2023-08-25

文章信息/Info

Title:
Individualized Treatment and Precise Surgical Strategies for the Root of Acute Type A Aortic Dissection
作者:
朱贵军 陈兴澎**
(郑州大学附属洛阳市中心医院心脏中心，洛阳471009)
Author(s):
Zhu Guijun;  Chen Xingpeng.
Heart Center, Luoyang Central Hospital, Zhengzhou University, Luoyang 471009, China
关键词:
急性Stanford A型主动脉夹层; 主动脉根部处理; 个体化; 孙氏手术
Keywords:
Acute Stanford type A aortic dissection; Treatment of aortic root; Individualization; Sun’s procedure
文献标志码:
C
摘要:
目的探讨急性A型主动脉夹层(acute type A aortic dissection，ATAAD)根部的个体化处理策略。方法回顾性分析我院2021年7月~2022年10月77例ATAAD资料，均在急性期(发病时间<14 d)行全主动脉弓替换及降主动脉支架象鼻人工血管置入术(孙氏手术)，根部施行个体化治疗与精准外科操作方案，应用“三明治”法31例，改良“三明治”法37例(人工血管片内衬和夹入，外垫毛毡条，其中3例冠脉开口撕裂行“铜钱样”牛心包片修复冠脉开口及窦的根部成形)，Bentall术5例，Wheat术1例，改良David术1例，改良Cabrol术2例。其中5例行单支或多支大隐静脉冠状动脉旁路移植术。结果死亡5例，其中2例心肌灌注不良，1例肾灌注不良，1例下肢灌注不良，1例病房猝死。出院72例，其中2例术后直接应用床旁血液滤过，术后出血二次开胸1例，胸骨愈合不良再次胸骨固定1例。出院前全部复查主动脉CTA及心脏超声，无主动脉瓣大量反流，无近端吻合口漏及残余夹层。术后随访3~12个月，平均6个月，均无临床症状，无死亡。术后随访心脏超声及主动脉CTA，无主动脉瓣大量反流。术后3个月随访69例，少量反流2例，中量反流3例；术后6个月随访60例，少量反流4例，中量反流2例；随访1年40例，少量反流5例，中量反流2例。结论应根据ATAAD根部病变的不同程度，应用不同的根部处理方法。
Abstract:
ObjectiveTo explore the individualized treatment and precise surgical strategies for the root of acute type A aortic dissection (ATAAD).MethodsA retrospective analysis was performed on data of 77 cases of ATAAD in our hospital from July 2021 to October 2022. All of them underwent Sun’s surgery (total aortic arch replacement and descending aorta stent and trunk artificial vascular implantation) in the acute stage (time of onset <14 d). The individualized treatment and precise surgical operation were performed on the root. Among them, 31 cases were treated with the “sandwich” method, 37 cases were treated with the modified “sandwich” method (lining and insertion of artificial blood vessel slices with felt strips on the outside, including 3 cases of coronary opening tear treated with “copper dollar” bovine pericardial slice to repair the coronary opening and sinuses), 5 cases were treated with the Bentall surgery, 1 case was treated with the Wheat surgery, 1 case was treated with the modified David surgery, and 2 cases were treated with the modified Cabrol surgery. There were 5 patients receiving single or multiple great saphenous vein coronary artery bypass grafting. ResultsThere were 5 fatal cases, including 2 cases of poor myocardial perfusion, 1 case of poor renal perfusion, 1 case of poor lower limb perfusion, and 1 case of sudden death in ward. The remaining 72 patients were discharged from hospital, of which 2 patients were given bedside hemofiltration after surgery, 1 patient had postoperative hemorrhage and underwent secondary thoracotomy, and 1 patient had poor sternal union and was given reoperation of sternal fixation. All the 72 patients were reexamined with aortic CTA and cardiac ultrasound before discharge, and there was no massive aortic regurgitation, proximal anastomotic leakage, or residual dissection. The postoperative followups lasted for 3-12 months (mean, 6 months), which consisted mainly of cardiac ultrasound and aortic CTA. There were no clinical symptoms or deaths. A total of 69 cases were followed up for 3 months after surgery, including 2 cases with mild regurgitation and 3 cases with moderate regurgitation. A total of 60 cases were followed up for 6 months after surgery, including 4 cases of mild regurgitation and 2 cases of moderate regurgitation. There were 40 cases followed up for 1 year, including 5 cases of mild regurgitation and 2 cases of moderate regurgitation.ConclusionDifferent root treatment methods and precise surgical operation techniques should be applied based on the different degrees of ATAAD root lesions.

参考文献/References:

[1]Evangelista A，Isselbacher EM，Bossone E，et al.Insights from the international registry of acute aortic dissection：a 20year xperience of collaborative clinical research.Circulation，2018，137：1846-1860.
[2]郭文静，胡杰，陈兴澎.右美托咪定对急性主动脉夹层患者镇痛和镇静的影响：前瞻性随机对照研究.中国微创外科杂志，2020，20(5)：397-400.
[3]方理刚,Navin C.NANDA,Ming Chon HSIUNG,等.实时三维经胸超声心动图测量缩流面积评价主动脉瓣反流.临床超声医学杂志,2008,10(3):148-150.
[4]吴龙，张凯伦，黄晓帆，等.改良David技术在急性A型主动脉夹层窦部成形中的应用.中华胸心血管外科杂志，2019，35(12)：731-734.
[5]孙立忠，李建荣.我国Stanford A型主动脉夹层诊疗进展与挑战.中华外科杂志，2017，55(4)：241-244.
[6]畅怡，钱向阳，郭宏伟，等.主动脉窦成形术修复急性Stanford A型主动脉夹层受累根部的近期效果.中国胸心血管外科临床杂志，2021，28(12)：1441-1446.
[7]胡诚凯，傅正，顾佳伟，等.根部修复术在累及主动脉窦的急性A型主动脉夹层中的应用.中华胸心血管外科杂志，2022，38(4)：204-209．
[8]Zhang D,Zhu GJ,Wei XY,et al.Repair of coronary artery ostium with a ringshaped bovine pericardial patch.Interact Cardiovasc Thorac Surg,2022,35(5):ivac251.
[9]蒋捷，顾嘉玺，刘鸿，等.“改良三明治”技术在急性A型主动脉夹层中的应用效果.医学研究生学报，2022，35(2)：175-179.
[10]崔金帅，晁文晗，高秉仁，等.主动脉根部疾病手术选择的研究进展.中国胸心血管外科临床杂志，2019，26(5)：504-508.
[11]Yang B，Malik A，Waidley V，et al.Shortterm outcomes of a simple and effective approach to aortic root and arch repair in a cute type A aortic dissection.J Thorac Cardiovasc Surg,2018，15(5)：1360-1370．
[12]王露辰，刘雁翔，顿耀军，等.“视而不见”主动脉根部修复术治疗急性Stanford A型主动脉夹层疗效的前瞻性.中华胸心血管外科杂志，2022，38(9)：559-564．

备注/Memo

备注/Memo:
基金项目：2019河南省医学科技攻关项目(LHGJ20191213)**通讯作者，Email：1245828464@qq.com
更新日期/Last Update: 2023-11-08