Staged Total Aortic Replacement for Acute Stanford A Aortic Dissection Accompanied with Thoracoabdominal Aortic Aneurysm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

黄福华 , 李良鹏 , 秦卫 , 苏存华 , 肖立琼 ,  陈鑫

南京医科大学附属南京医院南京市第一医院南京市心血管病医院心胸血管外科, 南京 210006;

Corresponding author：

陈鑫, Email: stevecx@sina.com

Keywords：

A型主动脉夹层; 胸腹主动脉瘤; 人工血管; 全主动脉置换

DOI：

10.7507/1007-4848.20160178

Video：

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目的总结采用分期全主动脉置换治疗急性A型主动脉夹层合并胸腹主动脉瘤的手术方式和早期治疗效果。方法自2013年2月至2014年2月，2例急性A型主动脉夹层合并Crawford Ⅱ型胸腹主动脉瘤的马方综合征患者进行了分期全主动脉置换手术。患者均为男性，年龄分别为41岁和26岁。一期在部分深低温停循环下行主动脉根部、全弓置换及支架象鼻植入术，二期在常温非体外循环下应用四分叉人工血管行全胸腹主动脉置换术。结果手术结果满意，2例患者均康复出院，无任何并发症。结论分期全主动脉置换术治疗急性A型主动脉夹层合并全胸腹主动脉瘤是一种安全、有效的方法。

Citation： 黄福华, 李良鹏, 秦卫, 苏存华, 肖立琼, 陈鑫. Staged Total Aortic Replacement for Acute Stanford A Aortic Dissection Accompanied with Thoracoabdominal Aortic Aneurysm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 746-748. doi: 10.7507/1007-4848.20160178 Copy

1.	Kallenbach K, Oelze T, Salcher R, et al. Evolving strategies for treatment of acute aortic dissection type A. Circulation, 2004, 110 (11 Suppl 1):Ⅱ243-249.
2.	刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2):148-149.
3.	Emmett M. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 106(25):e224.
4.	Crawford ES, Coselli JS, Svensson LG, et al. Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. Ann Surg, 1990, 211(5):521-537.
5.	Crawford ES, Stowe CL, Crawford JL, et al. Aortic arch aneurysm. A sentinel of extensive aortic disease requiring subtotal and total aortic replacement. Ann Surg, 1984, 199(6):742-752.
6.	Etz CD, Zoli S, Mueller CS, et al. Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg, 2010, 139(6):1464-1472.
7.	张明, 孙立忠, 刘永民, 等. 不同手术方式行全胸腹主动脉置换的临床研究. 中华胸心血管外科杂志, 2012, 28(2):68-71.
8.	程力剑, 孙立忠, 朱俊明, 等. 63例全胸腹主动脉置换术患者中期结果分析. 中国胸心血管外科临床杂志, 2009, 16(5):339-343.
9.	邓美海, 区庆嘉. 胸-腹主动脉瘤手术中辅助方法的应用. 中国胸心血管外科临床杂志, 1999, 6(3):86-88.
10.	赖颢, 王毓琳, 王春生, 等. 分期全主动脉置换术治疗主动脉夹层动脉瘤. 中国临床医学, 2012, 19(4):352-353.
11.	孙立忠, 程力剑, 朱俊明, 等. 常温非体外循环下全胸腹主动脉置换术. 中华胸心血管外科杂志, 2011, 27(12):705-711.
12.	黄福华, 陈鑫, 石开虎, 等. 胸腹主动脉瘤手术中重建肋间动脉的简易方法. 心肺血管病杂志, 2009, 28(2):78-81.
13.	邹以席, 黄方炯, 孙东, 等. 胸腹主动脉瘤手术中脑脊液引流对脊髓的保护作用. 中国胸心血管外科临床杂志, 2012, 19(2):154-158.
14.	Bisdas T, Panuccio G, Sugimoto M, et al. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. J Vasc Surg, 2015, 61(6):1408-1416.
15.	Safi HJ, Estrera AL, Azizzadeh A, et al. Progress and future challen-ges in thoracoabdominal aortic aneurysm management. World J Surg, 2008, 32(3):355-360.

1. Kallenbach K, Oelze T, Salcher R, et al. Evolving strategies for treatment of acute aortic dissection type A. Circulation, 2004, 110 (11 Suppl 1):Ⅱ243-249.
2. 刘宸铖, 郭应强, 蒙炜, 等. 全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层. 中国胸心血管外科临床杂志, 2009, 16(2):148-149.
3. Emmett M. Predicting death in patients with acute type A aortic dissection. Circulation, 2002, 106(25):e224.
4. Crawford ES, Coselli JS, Svensson LG, et al. Diffuse aneurysmal disease (chronic aortic dissection, Marfan, and mega aorta syndromes) and multiple aneurysm. Treatment by subtotal and total aortic replacement emphasizing the elephant trunk operation. Ann Surg, 1990, 211(5):521-537.
5. Crawford ES, Stowe CL, Crawford JL, et al. Aortic arch aneurysm. A sentinel of extensive aortic disease requiring subtotal and total aortic replacement. Ann Surg, 1984, 199(6):742-752.
6. Etz CD, Zoli S, Mueller CS, et al. Staged repair significantly reduces paraplegia rate after extensive thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg, 2010, 139(6):1464-1472.
7. 张明, 孙立忠, 刘永民, 等. 不同手术方式行全胸腹主动脉置换的临床研究. 中华胸心血管外科杂志, 2012, 28(2):68-71.
8. 程力剑, 孙立忠, 朱俊明, 等. 63例全胸腹主动脉置换术患者中期结果分析. 中国胸心血管外科临床杂志, 2009, 16(5):339-343.
9. 邓美海, 区庆嘉. 胸-腹主动脉瘤手术中辅助方法的应用. 中国胸心血管外科临床杂志, 1999, 6(3):86-88.
10. 赖颢, 王毓琳, 王春生, 等. 分期全主动脉置换术治疗主动脉夹层动脉瘤. 中国临床医学, 2012, 19(4):352-353.
11. 孙立忠, 程力剑, 朱俊明, 等. 常温非体外循环下全胸腹主动脉置换术. 中华胸心血管外科杂志, 2011, 27(12):705-711.
12. 黄福华, 陈鑫, 石开虎, 等. 胸腹主动脉瘤手术中重建肋间动脉的简易方法. 心肺血管病杂志, 2009, 28(2):78-81.
13. 邹以席, 黄方炯, 孙东, 等. 胸腹主动脉瘤手术中脑脊液引流对脊髓的保护作用. 中国胸心血管外科临床杂志, 2012, 19(2):154-158.
14. Bisdas T, Panuccio G, Sugimoto M, et al. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. J Vasc Surg, 2015, 61(6):1408-1416.
15. Safi HJ, Estrera AL, Azizzadeh A, et al. Progress and future challen-ges in thoracoabdominal aortic aneurysm management. World J Surg, 2008, 32(3):355-360.

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Staged Total Aortic Replacement for Acute Stanford A Aortic Dissection Accompanied with Thoracoabdominal Aortic Aneurysm

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