2018 年第 12 期 第 13 卷

左锁骨下动脉-左颈总动脉转流术联合支架象鼻治疗慢性Stanford_B型主动脉夹层累及远端弓的临床经验

Surgical treatment of chronic Stanford type B aortic dissection with distal aortic arch involvement using stented elephant trunk implantation combined with left subclavian artery to left common carotid artery bypass

作者：里程楠朱俊明齐瑞东杨祎于海邢晓燕刘永民孙立忠

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所北京市主动脉疾病诊疗中心

英文单位：

关键词：慢性StanfordB型主动脉夹层；支架象鼻；左锁骨下动脉-左颈总动脉转流术

英文关键词：

• 摘要：

• 【摘要】目的    回顾性总结采用左锁骨下动脉(LSCA)-左颈总动脉(LCCA)转流术联合支架象鼻植入治疗慢性Stanford B型主动脉夹层累及远端主动脉弓的临床经验。方法    2011年1月至2015年9月，26例慢性Stanford B型主动脉夹层累及远端主动脉弓患者在首都医科大学附属北京安贞医院心脏外科中心接受支架象鼻植入联合LSCA-LCCA转流术，对此部分患者临床资料行回顾性分析。其中男21例、女5例，平均年龄（48±10）岁。结果    26例患者中院内死亡2例（7.7%）。同期手术包括Bentall+冠状动脉旁路移植术1例，主动脉瓣置换术+二尖瓣置换术+三尖瓣成形术1例，二尖瓣成形术1例。3例患者术后呼吸机辅助时间超过24 h，平均呼吸机辅助时间和住重症监护病房时间分别为（18±8）、（40±27）h。随访期间，1例患者于术后21个月死亡，死亡原因不明。随访期间1例患者行胸腹主动脉替换。结论    应用支架象鼻植入术联合LSCA-LCCA转流术治疗慢性Stanford B型主动脉夹层累及远端弓，避免了介入治疗的相关并发症，获得了满意的临床效果。

• 【Abstract】Objective    To review the surgical experience of chronic Stanford type B aortic dissection with distal aortic arch involvement treated by stented elephant trunk implantation combined with left subclavian artery(LSCA) to left common carotid artery(LCCA) bypass. Methods    From January 2011 to September 2015, clinical data of 26 patients with chronic Stanford type B dissection with distal aortic arch involvement［21 males, 5 females, the mean age (48±10)years］ who underwent stented elephant trunk procedure with LSCA-LCCA bypass in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Results    In 26 patients, there were 2 in-hospital deaths(7.7%). Concomitant procedures included Bentall procedure+coronary artery bypass grafting in 1 patient, replacement of aortic valve and mitral valve with plasty of tricuspid valve in 1 patient, mitral valve plasty in 1 patient. Ventilator support exceeded 24 h in 3 patients. The mean ventilator support time and the length of intensive care unit stay were （18±8） and （40±27）h, respectively. During follow-up, 1 patient died 21 months after operation and the cause of death was unknown; 1 patient had thoracoabdominal aortic replacement. Conclusion    Stented elephant trunk procedure with LSCA-LCCA bypass obtains satisfactory surgical Results in chronic Stanford type B aortic dissection with distal aortic arch involvement.