• 南京醫(yī)科大學(xué)附屬南京第一醫(yī)院 南京市心血管病研究所 心胸外科， 南京 210006;

目的 探討急性Stanford A型主動(dòng)脈夾層外科治療經(jīng)驗(yàn)、手術(shù)時(shí)機(jī)、方式，以提高手術(shù)效果。 方法 回顧性分析近8年來外科手術(shù)治療的29例急性Stanford A型主動(dòng)脈夾層患者的臨床資料和隨訪結(jié)果。Stanford A型主動(dòng)脈夾層外科手術(shù)治療的主要原則為切除內(nèi)膜撕裂、易破裂的部分主動(dòng)脈，修復(fù)剝離內(nèi)膜，再用人工血管移植成形或置換，再建主動(dòng)脈管道，同期處理合并的心瓣膜、心肌缺血病變。 結(jié)果 全組急診手術(shù)13例，亞急診（限期）手術(shù)16例。術(shù)后早期死亡2例（6.9%) ，其中1例術(shù)后死于嚴(yán)重心律失常，1例死于多器官功能衰竭。術(shù)后二次開胸止血6例，發(fā)生肺部感染、呼吸衰竭3例，延遲蘇醒4例，急性腎功能衰竭2例，上消化道出血1例，均經(jīng)相應(yīng)的處理治愈出院。隨訪24例（88.9%) ，隨訪時(shí)間23.6±10.1個(gè)月，1例行Bentall手術(shù)后16個(gè)月發(fā)生心內(nèi)膜炎伴腦出血死亡，1例全弓置換+升主動(dòng)脈置換術(shù)后26個(gè)月猝死，其余患者生活質(zhì)量良好。 結(jié)論 盡早手術(shù)是降低急性Stanford A型主動(dòng)脈夾層病死率的關(guān)鍵，根據(jù)夾層破口的位置、累及范圍、主動(dòng)脈瓣及根部增寬情況來選擇相應(yīng)的術(shù)式，以簡化的手術(shù)、良好的療效為原則。

引用本文： 邱志兵,陳鑫,徐明等. 急性Stanford A型主動(dòng)脈夾層的外科治療. 中國胸心血管外科臨床雜志, 2007, 14(6): 426-. doi: 復(fù)制

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9. 　石應(yīng)康，張爾永，田子樸,等. 升主動(dòng)脈和弓部動(dòng)脈瘤的外科治療. 中國胸心血管外科臨床雜志， 2003, 10 (1) : 6-8.
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11. 　Shiono M, Hata M,Sezai A,et al. Emergency surgery for acute type a aortic dissection in octogenarians. Ann Thorac Surg, 2006,82(2):554-559.
12. 　張爾永，石應(yīng)康，田子樸,等. A型主動(dòng)脈夾層動(dòng)脈瘤的外科治療.中國胸心血管外科臨床雜志， 2002, 9 (4) : 251-253.
  1. 1. 　Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A.Ann Thorac Surg, 2002,73(3):714-718.
  2. 2. 　Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283 (7) :897-903.
  3. 3. 　孫立忠，劉寧寧，常謙，等. 主動(dòng)脈夾層的細(xì)化分型及其應(yīng)用.中華外科雜志，2005, 43 (18) : 1171-1176.
  4. 4. 　Fuster V, Ip JH. Medical aspects of acute aortic dissection. Semin Thorac Cardiovasc Surg, 1991,3(3):219-224.
  5. 5. 　Trimarchi S, Nienaber CA, Rampoldi V,et al. contemporary results of surgery in acute type A aortic dissection: the international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg, 2005, 129(1): 112-122.
  6. 6. 　Dossche KM,Schepens MA, Morshuis WJ, et al. Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta. Ann Thorac Surg, 1999,67(6):1904-1921.
  7. 7. 　Langer F, Aicher D, Kissinger A, et al. Aortic valve repair using a differentiated surgical strategy. Circulation, 2004,110(11 Suppl 1):II67-II73.
  8. 8. 　Halstead JC, Spielvogel D, Meier DM,et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications Eur J Cardiothorac Surg,2005,27(4):626-632.
  9. 9. 　石應(yīng)康，張爾永，田子樸,等. 升主動(dòng)脈和弓部動(dòng)脈瘤的外科治療. 中國胸心血管外科臨床雜志， 2003, 10 (1) : 6-8.
  10. 10. 　Schepens MA, Dossche KM, Morshuis WJ, et al. The elephant trunk technique: operative results in 100 consecutive patients. Eur J Cardiothorac Surg,2002,21(2):276-281.
  11. 11. 　Shiono M, Hata M,Sezai A,et al. Emergency surgery for acute type a aortic dissection in octogenarians. Ann Thorac Surg, 2006,82(2):554-559.
  12. 12. 　張爾永，石應(yīng)康，田子樸,等. A型主動(dòng)脈夾層動(dòng)脈瘤的外科治療.中國胸心血管外科臨床雜志， 2002, 9 (4) : 251-253.