临床外科杂志 ›› 2023, Vol. 31 ›› Issue (9): 815-818.doi: 10.3969/j.issn.1005-6483.2023.09.005

• 论著 • 上一篇    下一篇

Hybrid Ⅱ型杂交和全弓置换术在急性Stanford A型主动脉夹层合并脏器灌注不良的疗效比较

  

  1. 430060 武汉大学人民医院心血管外科 
  • 收稿日期:2023-02-09 出版日期:2023-09-20 发布日期:2023-09-20
  • 通讯作者: 王志维,Email:wangzhiwei@whu.edu.cn
  • 基金资助:
    国家自然科学基金(82070481) 

Comparison between hybrid debranching and total arch treatment in acute Stanford A aortic dissection with malperfusion

  1. Department of Cardiovascular Surgery,Renmin Hospital of Wuhan University,Hubei,Wuhan 430060,China
  • Received:2023-02-09 Online:2023-09-20 Published:2023-09-20

摘要: 目的 比较Hybrid Ⅱ型杂交与全弓置换术治疗急性A型主动脉夹层合并脏器灌注不良的疗效。方法 2016年1月~2020年1月我院诊治的急性A型主动脉夹层合并脏器灌注不良病人127例,按手术方法不同分为两组,Hybrid组56例,采用Hybrid Ⅱ型杂交手术,全弓置换组71例,采用全弓置换术。结果 Hybrid Ⅱ组和全弓置换组术后呼吸机辅助时间分别为(32.6±26.7)小时和(61.8±31.1)小时,术后ICU住院时间分别为(75.3±30.6)小时和(104.4±34.1)小时,术后肾功能不全发生率分别为21.4%和46.5%,术后30天内死亡率分别为1.8%和12.7%,术后1年内死亡率分别为5.4%和18.3%,永久性神经功能损伤分别为8.9%和 22.5%,两组比较,差异有统计学意义(P<0.05)。术后二次开胸止血、肝功能不全、气管切开、暂时性神经功能损伤、术后3年内死亡率及内漏发生率比较,差异无统计学意义。结论 急性A型主动脉夹层合并脏器灌注不良病人,行Hybrid Ⅱ型杂交手术近期预后满意,远期预后有待进一步研究。

关键词: A型主动脉夹层, 脏器灌注不良, 全弓置换, Hybrid Ⅱ型杂交

Abstract: Objectives  To investigate the clinical outcomes of Hybrid Ⅱ and total arch replacement in acute type A aortic dissection(ATAAD) with malperfusion. Methods From January 2016 to January 2020, 127 ATAAD patients with malperfusion who underwent surgical repair were enrolled in this study.There were 56 patients in hybrid debranching group and 71 in total arch replacement group.Their baseline characteristics,perioperative data,and early and mid-term outcomes were compared.Results Compared with the total arch replacement surgery group,the postoperative ventilator assistance time[(32.6±26.7)h vs(61.8±31.1)h],intensive care unit length of stay[(75.3±30.6)h vs (104.4±34.1)h],postoperative renal insufficiency(21.4% vs 46.5%),mortality within 30 days(1.8% vs 12.7%),mortality within 1 year(5.4% vs 18.3%) and permanent neurological dysfunction(8.9% vs 22.5%) in the hybrid debranching group were all statistically significant(P<0.05).There were no differences in re-exploration,hepatic insufficiency,tracheotomy,temporary neurological dysfunction,mortality within 3 years and endoleak.Conclusion Hybrid debranching had better advantages in improving the short-term prognosis of ATAAD patients with malperfusion,but the long-term prognosis needed further study.

Key words: stanford A aortic dissection, malperfusion, total arch replacement, hybrid debranching

[1] 张洁 郑智 潘友民. 肥胖对急性A型主动脉夹层术后并发症的影响[J]. 临床外科杂志, 2023, 31(4): 344-347.
[2] 周永智 魏翔 邓朋 王靖 杨建业 王星宇 胡敏. 经胸骨上段小切口行A型主动脉夹层手术[J]. 临床外科杂志, 2023, 31(3): 238-241.
[3] 马先桃 李师亮 严丽 朱章强 冯异 程才. 杂交技术在StanfordA型主动脉夹层的应用现状[J]. 临床外科杂志, 2021, 29(12): 1101-1103.
[4] 范迪堃 王志维 夏军等. 策略性的全弓置换及支架象鼻术在大血管疾病外科治疗中的应用 [J]. 临床外科杂志, 2013, 21(3): 192-194.
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