急性A型主动脉夹层合并下肢缺血的诊疗

doi:10.3969/j.issn.1006-7795.2015.03.008

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (3): 376-381.doi: 10.3969/j.issn.1006-7795.2015.03.008

• 心脏大血管外科领域前沿进展 • 上一篇下一篇

急性A型主动脉夹层合并下肢缺血的诊疗

戎天华, 刘永民, 朱俊明, 马维国, 张巍, 王龙飞, 赵宏磊, 潘旭东, 孙立忠

首都医科大学附属北京安贞医院心脏外科北京市大血管疾病诊疗研究中心, 北京 100029

收稿日期:2015-03-18 出版日期:2015-06-21 发布日期:2015-06-15
通讯作者: 孙立忠 E-mail:lizhongsun@outlook.com
基金资助:
国家卫计委公益性行业科研专项项目(201402009).

Management of acute type A aortic dissection complicated with lower limb ischemia

Rong Tianhua, Liu Yongmin, Zhu Junming, Ma Weiguo, Zhang Wei, Wang Longfei, Zhao Honglei, Pan Xudong, Sun Lizhong

Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Aortic Disease Center, Capital Medical University, Beijing 100029, China

Received:2015-03-18 Online:2015-06-21 Published:2015-06-15
Supported by:
This study was supported by the National Health Planning Commission Nonprofit Industry Research Subject(201402009).

摘要/Abstract

摘要：

目的探讨孙氏手术治疗急性A型主动脉夹层合并下肢缺血的临床效果.方法自2009年7月至2014年1月期间首都医科大学附属北京安贞医院连续收治急性A型主动脉夹层合并下肢缺血的患者27例,其中男性23例,女性4例,平均年龄(48.1±7.9)岁.所有患者在深低温停循环,顺行选择性单侧脑灌注下行四分支人工血管全主动脉弓替换加支架象鼻人工血管植入术(孙氏手术).近端行主动脉瓣成型加升主动脉替换术7例,单纯升主动脉替换术10例,Bentall手术8例,改良David手术1例.同期行冠状动脉旁路移植术(coronary artery bypass graft, CABG)术2例,升主动脉-股动脉转流术5例,股动脉-股动脉转流术2例.结果全组平均体外循环时间(209±61)min,主动脉阻断时间(119±38)min,深低温停循环时间(27±11)min.术后早期病死率14.8%(4/27),合并症发生率55.6%(15/27).术后随访(41±27)个月,随访率87.0%(20/23),因脑血管事件死亡1例,无主动脉相关死亡病例,术后1月二期行股动脉-股动脉转流术1例,存活患者总体下肢缺血康复率为90.9%(20/22).结论应用孙氏手术治疗急性A型主动脉夹层合并下肢缺血是安全、可行且有效的,必要时可同期或二期行各类转流手术来帮助重建下肢血运.术前应对患者进行全面的评估,合理把握手术指征.

关键词: 主动脉夹层, 下肢缺血, 孙氏手术

Abstract:

Objective To explore the effect of Sun's procedure for type A acute aortic dissection complicated with lower limb ischemia. Methods From July 2009 to January 2014, 27 consecutive patients were diagnosed as type A acute aortic dissection complicated with lower limb ischemia and underwent total arch replacement using a tetrafurcated graft with stented elephant trunk implantation(Sun's procedure). There were 23 males and 3 females with an average age of (48.1±7.9)years. Concomitant proximal procedures included: aortic valve repair plus ascending aorta replacement in 7 patients, ascending aorta replacement alone in 10 patients, Bentall procedure in 8 patients and modified David procedure in 1 patient. Other concomitant procedures were: CABG in 2 patients, ascending aortic-femoral arterial bypass in 5 patients and femoral-femoral arterial bypass in 2 patients. Results Average extracorporeal circulation time was(209±61)min, average aortic cross-clamp time was(119±38)min, and the average circulatory arrest time was(27±11)min. Early mortality rate was 14.8%(4/27)and the morbidity rate was 55.6%(15/27). Mean time of follow-up was(41±27)month with a follow-up rate of 87.0%(20/23). One patient died of cerebrovascular event. No aortic related death occurred. One patient received secondary femoral-femoral artery bypass one month after Sun's procedure and recovered well. The overall lower limb ischemia recovery rate of operation survivors was 90.9%(20/22). Conclusion Sun's procedure is safe, feasible and effective for type A acute aortic dissection complicated with lower limb ischemia. Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary. Comprehensive evaluation of patient's status is strongly recommended for optimal surgical decision making.

Key words: aortic dissection, lower limb ischemia, Sun's procedure

中图分类号:

R654

戎天华, 刘永民, 朱俊明, 马维国, 张巍, 王龙飞, 赵宏磊, 潘旭东, 孙立忠. 急性A型主动脉夹层合并下肢缺血的诊疗[J]. 首都医科大学学报, 2015, 36(3): 376-381.

Rong Tianhua, Liu Yongmin, Zhu Junming, Ma Weiguo, Zhang Wei, Wang Longfei, Zhao Honglei, Pan Xudong, Sun Lizhong. Management of acute type A aortic dissection complicated with lower limb ischemia[J]. Journal of Capital Medical University, 2015, 36(3): 376-381.

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急性A型主动脉夹层合并下肢缺血的诊疗

Management of acute type A aortic dissection complicated with lower limb ischemia

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