主动脉头臂血管转流术与孙氏手术治疗急性Stanford A型主动脉夹层的疗效比较

Comparison of the therapeutic efficacy of aorto-brachiocephalic bypass surgery and Sun's procedure for acute Stanford type A aortic dissection

摘要:

目的 比较主动脉头臂血管转流术与孙氏手术治疗急性Stanford A型主动脉夹层疗效。方法 选取2015年3月—2018年3月武汉市第一医院收治的急性Stanford A型主动脉夹层患者82例。按照不同手术方法分为血管转流术组和孙氏手术组，分别为39例和43例。比较两组患者手术时间、术中出血量、体外循环时间、主动脉阻断时间和选择性脑灌注时间，比较两组患者术前和术后1年左心室射血分数、升主动脉最大内径和左心室舒张末期内径。随访3年，比较两组患者并发症发生情况和生存情况。结果 两组患者基本资料比较，差异无统计学意义（P >0.05）。两组患者体外循环时间比较，差异无统计学意义（P >0.05），血管转流术组手术时间、主动脉阻断时间和选择性脑灌注时间短于孙氏手术组，术中出血量少于孙氏手术组（P <0.05）。两组患者手术前后左心室射血分数、升主动脉最大内径和左心室舒张末期内径比较，差异无统计学意义（P >0.05）。两组患者治疗后左心室射血分数较治疗前升高，术后升主动脉最大内径、左心室舒张末期内径均较术前缩小（P <0.05）。血管转流术组并发症总发生率低于孙氏手术组（P <0.05）。随访3年，孙氏手术组患者有1例患者于术后31个月因心力衰竭死亡，血管转流术组患者无死亡。结论 主动脉头臂血管转流术用于治疗急性Stanford A型主动脉夹层，能够减少手术时间、术中出血量、主动脉阻断时间和选择性脑灌注时间，且并发症发生率较低，安全可靠。

Abstract:

Objective To compare the therapeutic efficacy of aorto-brachiocephalic bypass surgery and Sun's procedure for acute Stanford type A aortic dissection.Methods Eighty-two patients with acute Stanford type A aortic dissection admitted to the hospital from March 2015 to March 2018 were selected and divided into vascular bypass surgery group (n = 39) and Sun's procedure group (n = 43) according to different surgical methods. The operative duration, intraoperative blood loss, duration of extracorporeal circulation, duration of aortic cross-clamping, and duration of selective cerebral perfusion were compared between the two groups of patients. The left ventricular ejection fraction, the maximum internal diameter of the ascending aorta, and the left ventricular end-diastolic diameter before and 1 year after the operation were compared between the two groups. After 3 years of follow-up, the incidence of complications and survival of the patients in the two groups were also compared.Results There was no statistically significant difference in the general characteristics of the two groups of patients (P > 0.05). There was no statistically significant difference in the duration of extracorporeal circulation between the vascular bypass surgery group and the Sun's procedure group (P > 0.05), whereas the operative duration, duration of aortic cross-clamping, and duration of selective cerebral perfusion were shorter, and intraoperative blood loss was lower in the vascular bypass surgery group compared with the Sun's procedure group (P < 0.05). There was no significant difference in left ventricular ejection fraction, the maximum internal diameter of the ascending aorta, and the left ventricular end-diastolic diameter before and after the surgery between the two groups (P > 0.05). After the surgery, the left ventricular ejection fraction was increased (P < 0.05), while the maximum internal diameter of the ascending aorta and the left ventricular end-diastolic diameter were decreased in the two groups (P < 0.05). The overall incidence of complications in the vascular bypass surgery group was lower than that in the Sun's procedure group (P < 0.05). During 3 years of follow-up, one patient in the Sun's procedure group died of heart failure 31 months after surgery, while there was no death in the vascular bypass surgery group.Conclusions The aorto-brachiocephalic bypass surgery reduces the operative duration, intraoperative blood loss, duration of aortic cross-clamping, and duration of selective cerebral perfusion in the treatment of acute Stanford type A aortic dissection, with a low incidence of complications and few safety concerns.