Qi R D, Zhu J M, Chen L, Li C N, Qiao Z Y, Cheng L J, Ge Y P, Hu H O, Xia Y, Xing X Y, Zheng T, Liu Y M, Sun L Z
Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2017 Jun 27;97(24):1867-1870. doi: 10.3760/cma.j.issn.0376-2491.2017.24.005.
To study the surgical treatment of chronic type B dissection with aortic arch involvement using Sun's procedure. Between February 2009 and December 2015, 29 patients [20 males, 9 females, with a mean age of (41±12) years, range 24-64 years] with type B dissection with aortic arch involvement underwent Sun's procedure. Sixteen patient had a history of hypertension. Marfan syndrome was observed in 9 cases, coronary artery disease in 3 cases, mitral regurgitation in 3 patients, cerebrovascular disease in one patient. Twenty-two patients suffered proximal aortic arch disease, 4 cases experienced history of aortic root procedure and 2 subjects had history of pregnancy. Four patients had aortic arch malformation. One case suffered from massive cerebral infarction after surgery and died in another hospital. Concomitant procedures included mitral valve replacement in 3 cases, coronary artery bypass grafting in 3 patients, reconstruction of the right aberrant subclavian artery in one patient. Ventilator support exceeding 24 hours obseved in 2 patients. One of them recieved continuous renal replacement therapy and recovered before discharge. Spinal cord injury was obseved in one case, brain infarction in one patient and pericardial drainage in one case. Two patients required tracheotomy. During 12-94 (43±23) months' follow-up, thoracoabdominal aortic replacment was performed in 4 patients, thoracic endovascular aortic repair (TEVAR) in 2 subjects and repair of perivalvular leakage in one patient. Sun's procedure obtained satisfactory results in patients with chronic type B dissection with aortic arch involvement. Concomitant repair of proximal aortic arch lesions and distal type B dissection can be adopted using Sun's procedure.
探讨采用孙氏手术治疗累及主动脉弓的慢性B型主动脉夹层的疗效。2009年2月至2015年12月，29例累及主动脉弓的B型主动脉夹层患者[男20例，女9例，平均年龄(41±12)岁，范围24 - 64岁]接受了孙氏手术。16例患者有高血压病史。9例观察到马方综合征，3例有冠状动脉疾病，3例有二尖瓣反流，1例有脑血管疾病。22例患者有主动脉弓近端病变，4例有主动脉根部手术史，2例有妊娠史。4例有主动脉弓畸形。1例术后发生大面积脑梗死，转至外院死亡。同期手术包括3例二尖瓣置换术，3例冠状动脉旁路移植术，1例右锁骨下动脉异常重建术。2例患者呼吸机支持超过24小时。其中1例接受持续肾脏替代治疗，出院前康复。观察到1例脊髓损伤，1例脑梗死，1例心包引流。2例患者需要气管切开术。在12 - 94(43±23)个月的随访期间，4例患者接受了胸腹主动脉置换术，2例接受了胸主动脉腔内修复术(TEVAR)，1例接受了瓣周漏修补术。孙氏手术治疗累及主动脉弓的慢性B型主动脉夹层患者取得了满意的效果。孙氏手术可同时用于修复主动脉弓近端病变和远端B型夹层。
