• 南京醫(yī)科大學附屬南京第一醫(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型主動脈夾層外科治療經驗、手術時機、方式，以提高手術效果。 方法 回顧性分析近8年來外科手術治療的29例急性Stanford A型主動脈夾層患者的臨床資料和隨訪結果。Stanford A型主動脈夾層外科手術治療的主要原則為切除內膜撕裂、易破裂的部分主動脈，修復剝離內膜，再用人工血管移植成形或置換，再建主動脈管道，同期處理合并的心瓣膜、心肌缺血病變。 結果 全組急診手術13例，亞急診（限期）手術16例。術后早期死亡2例（6.9%) ，其中1例術后死于嚴重心律失常，1例死于多器官功能衰竭。術后二次開胸止血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，均經相應的處理治愈出院。隨訪24例（88.9%) ，隨訪時間23.6±10.1個月，1例行Bentall手術后16個月發(fā)生心內膜炎伴腦出血死亡，1例全弓置換+升主動脈置換術后26個月猝死，其余患者生活質量良好。 結論 盡早手術是降低急性Stanford A型主動脈夾層病死率的關鍵，根據夾層破口的位置、累及范圍、主動脈瓣及根部增寬情況來選擇相應的術式，以簡化的手術、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: 復制

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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. 　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. 　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. 　石應康，張爾永，田子樸,等. 升主動脈和弓部動脈瘤的外科治療. 中國胸心血管外科臨床雜志， 2003, 10 (1) : 6-8.
10. 　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. 　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，石應康，田子樸,等. A型主動脈夾層動脈瘤的外科治療.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. 主動脈夾層的細化分型及其應用.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. 　石應康，張爾永，田子樸,等. 升主動脈和弓部動脈瘤的外科治療. 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，石應康，田子樸,等. A型主動脈夾層動脈瘤的外科治療.中國胸心血管外科臨床雜志， 2002, 9 (4) : 251-253.