2019 年第 5 期 第 14 卷

A型主动脉夹层合并先天性多囊肾的外科治疗

Surgical treatment of type A aortic dissection with polycystic kidney

作者：程鹏葛翼鹏齐瑞东钟永亮乔志钰里程楠朱俊明

英文作者：

单位：100029首都医科大学附属北京安贞医院心外七科

英文单位：

关键词：A型主动脉夹层；多囊肾；外科治疗

英文关键词：

• 摘要：

• 【摘要】目的    探讨A型主动脉夹层合并先天性多囊肾的外科治疗效果。方法    选取2014年11月至2018年3月首都医科大学附属北京安贞医院收治的11例A型主动脉夹层合并先天性多囊肾患者，其中1例术前主动脉夹层破裂死亡，1例因家属拒绝手术行保守治疗，剩余9例患者均行外科手术治疗。分析手术患者一般资料、手术结果和随访情况。结果    9例手术患者中男6例、女3例，平均年龄（46±10）岁,行主动脉根部替换(Bentall术)6例、升主动脉替换3例、部分主动脉弓替换1例、全主动脉弓替换+象鼻支架植入术8例、二尖瓣置换1例、三尖瓣成形1例、左颈总动脉-左椎动脉转流1例。患者平均手术时间（480±105）min，体外循环时间（229±32）min，主动脉阻断时间（122±32）min，选择性脑灌注时间（20±11）min。所有患者均成功完成手术，院内死亡1例。术后新发肾功能不全1例，低氧血症2例，新发脑梗死1例。随访率100%，最长随访时间48个月，最短6个月，全组无主动脉相关二次手术，无肾功能衰竭。结论    对于合并先天性多囊肾的A型主动脉夹层患者，行低温停循环手术治疗具有良好的近期结果。

• 【Abstract】Objective    To analyze the surgical effect on patients with type A aortic dissection complicated with polycystic kidney. Methods    Eleven patients with type A aortic dissection complicated with congenital polycystic kidney were observed in Beijing Anzhen Hospital, Capital Medical University from November 2014 to March 2018. One patient died of rupture of aortic dissection; 1 patient had conservative treatment; 9 patient received surgery. General data, surgical results and follow-up outcomes were analyzed. Results    There were 6 males and 3 females with an average age of （46±10）years. Among the 9 patients, 6 patients underwent aortic root replacement(Bentall); 3 patients underwent ascending aorta replacement; 1 patient underwent partial aortic arch replacement; 8 patients underwent total aortic arch replacement plus stent implantation; mitral valve replacement, tricuspid valvuloplasty and left common carotid artery-left vertebral artery bypass were performed in 1 patient respectively. Average operation time was （480±105）min; cardiopulmonary bypass time was （229±32）min; aortic occlusion time was （122±32）min; selective cerebral perfusion time was （20±11）min. All patients completed the operation; 1 patient died in hospital. There was 1 case of renal insufficiency, 2 cases of hypoxemia and 1 case of cerebral infarction occurring after operation. The follow-up rate was 100%; no secondary aortic surgery and renal failure occurred during 48 months to 6 months of follow-up. Conclusion    Surgical treatment with hypothermic circulatory arrest has a good short-term effect on type A aortic dissection with polycystic kidney.