老年 Stanford A型主动脉夹层外科治疗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

何杰 ^1,3 ,  范小平 ¹ , 黄劲松 ¹ , 彭继海 ² , 张鸣生 ² , 蔡诗豪 ^1,3 , 许文柳 ³

1. ;
2. ;
3. ;

Corresponding author：

范小平, Email: fukui-hanson@hotmail.com

Keywords：

主动脉夹层; 老年; 外科治疗

DOI：

10.7507/1007-4848.201803074

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目的总结老年 Stanford A 型主动脉夹层（Stanford type A aortic dissection，AAD）外科治疗经验，探讨手术方式和要点，以提高外科治疗疗效。方法 2014 年 12 月至 2017 年 12 月对 23 例老年 Stanford A 型主动脉夹层患者（年龄≥70 岁）行手术治疗，均在全身麻醉、低温停循环及双侧顺行性脑灌注下进行。其中男 18 例、女 5 例，年龄（73.6±4.1）岁。结果全组体外循环时间（207.5±38.3）min，主动脉阻断时间（148.1±35.7）min，停循环时间（9.4±5.1）min，手术时间（7.2±3.6）h，术后体外膜肺氧合（extracorporeal memberane oxygenation，ECMO）支持 2 例，透析 4 例，2 例（8.9%）住院期死亡。全组患者出院前及术后 3 个月复查主动脉全程 CT 提示：覆膜支架及其分支血管通畅无狭窄，支架位置正常，主动脉弓及降主动脉假腔完全血栓化 19 例，部分血栓化 3 例。结论对于老年 Stanford A 型主动脉夹层患者，外科治疗仍是首选。减少或避免低温尤其是深低温停循环对患者的负面影响，最大限度缩短全身重要脏器缺血时间及总体手术时间是手术成功的关键。

Citation： 何杰, 范小平, 黄劲松, 彭继海, 张鸣生, 蔡诗豪, 许文柳. 老年 Stanford A型主动脉夹层外科治疗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(5): 514-518. doi: 10.7507/1007-4848.201803074 Copy

1.	Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
2.	Dai XF, Chen LW, Chen DZ, et al. Analysis of surgical treatment for Standford type A aortic dissection. Zhonghua Wai Ke Za Zhi, 2008, 46(11): 823-825.
3.	Minakawa M, Fukuda I, Yamauchi S, et al. Early and long-term outcome of total arch replacement using selective cerebral perfusion. Ann Thorac Surg, 2010, 90(1): 72-77.
4.	Stevens LM, Madsen JC, Isselbacher EM, et al. Surgical management and long-term outcomes for acute ascending aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1349-1357.
5.	Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg, 2010, 140(4): 784-789.
6.	Rylski B, Suedkamp M, Beyersdorf F, et al. Outcome after surgery for acute aortic dissection type A in patients over 70 years: data analysis from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg, 2011, 40(2): 435-440.
7.	Ma WG, Zheng J, Dong SB, et al. Sun's procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection. Ann Cardiothorac Surg, 2013, 2(5): 621-628.
8.	Zhang Q, Ma X, Zhang W, et al. Surgical repair and reconstruction of aortic arch in de Bakey type Ⅰ aortic dissection: recent advances and single-center experience in the application of branched stent graft. J Cardiothorac Surg, 2017, 12(1): 86.

1. Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol, 2015, 66(4): 350-358.
2. Dai XF, Chen LW, Chen DZ, et al. Analysis of surgical treatment for Standford type A aortic dissection. Zhonghua Wai Ke Za Zhi, 2008, 46(11): 823-825.
3. Minakawa M, Fukuda I, Yamauchi S, et al. Early and long-term outcome of total arch replacement using selective cerebral perfusion. Ann Thorac Surg, 2010, 90(1): 72-77.
4. Stevens LM, Madsen JC, Isselbacher EM, et al. Surgical management and long-term outcomes for acute ascending aortic dissection. J Thorac Cardiovasc Surg, 2009, 138(6): 1349-1357.
5. Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg, 2010, 140(4): 784-789.
6. Rylski B, Suedkamp M, Beyersdorf F, et al. Outcome after surgery for acute aortic dissection type A in patients over 70 years: data analysis from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg, 2011, 40(2): 435-440.
7. Ma WG, Zheng J, Dong SB, et al. Sun's procedure of total arch replacement using a tetrafurcated graft with stented elephant trunk implantation: analysis of early outcome in 398 patients with acute type A aortic dissection. Ann Cardiothorac Surg, 2013, 2(5): 621-628.
8. Zhang Q, Ma X, Zhang W, et al. Surgical repair and reconstruction of aortic arch in de Bakey type Ⅰ aortic dissection: recent advances and single-center experience in the application of branched stent graft. J Cardiothorac Surg, 2017, 12(1): 86.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

老年 Stanford A型主动脉夹层外科治疗

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