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

Authors：

黃福華 , 李良鵬 , 秦衛 , 蘇存華 , 肖立瓊 ,  陳鑫

南京醫科大學附屬南京醫院南京市第一醫院南京市心血管病醫院心胸血管外科, 南京 210006;

Corresponding?author：

陳鑫, Email: stevecx@sina.com

Keywords：

A型主動脈夾層; 胸腹主動脈瘤; 人工血管; 全主動脈置換

DOI：

10.7507/1007-4848.20160178

Video：

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目的總結采用分期全主動脈置換治療急性A型主動脈夾層合并胸腹主動脈瘤的手術方式和早期治療效果。方法自2013年2月至2014年2月，2例急性A型主動脈夾層合并Crawford Ⅱ型胸腹主動脈瘤的馬方綜合征患者進行了分期全主動脈置換手術。患者均為男性，年齡分別為41歲和26歲。一期在部分深低溫停循環下行主動脈根部、全弓置換及支架象鼻植入術，二期在常溫非體外循環下應用四分叉人工血管行全胸腹主動脈置換術。結果手術結果滿意，2例患者均康復出院，無任何并發癥。結論分期全主動脈置換術治療急性A型主動脈夾層合并全胸腹主動脈瘤是一種安全、有效的方法。

Citation： 黃福華, 李良鵬, 秦衛, 蘇存華, 肖立瓊, 陳鑫. 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.	劉宸鋮, 郭應強, 蒙煒, 等. 全主動脈弓置換加支架象鼻手術治療A型主動脈夾層. 中國胸心血管外科臨床雜志, 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.	張明, 孫立忠, 劉永民, 等. 不同手術方式行全胸腹主動脈置換的臨床研究. 中華胸心血管外科雜志, 2012, 28(2):68-71.
8.	程力劍, 孫立忠, 朱俊明, 等. 63例全胸腹主動脈置換術患者中期結果分析. 中國胸心血管外科臨床雜志, 2009, 16(5):339-343.
9.	鄧美海, 區慶嘉. 胸-腹主動脈瘤手術中輔助方法的應用. 中國胸心血管外科臨床雜志, 1999, 6(3):86-88.
10.	賴顥, 王毓琳, 王春生, 等. 分期全主動脈置換術治療主動脈夾層動脈瘤. 中國臨床醫學, 2012, 19(4):352-353.
11.	孫立忠, 程力劍, 朱俊明, 等. 常溫非體外循環下全胸腹主動脈置換術. 中華胸心血管外科雜志, 2011, 27(12):705-711.
12.	黃福華, 陳鑫, 石開虎, 等. 胸腹主動脈瘤手術中重建肋間動脈的簡易方法. 心肺血管病雜志, 2009, 28(2):78-81.
13.	鄒以席, 黃方炯, 孫東, 等. 胸腹主動脈瘤手術中腦脊液引流對脊髓的保護作用. 中國胸心血管外科臨床雜志, 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. 劉宸鋮, 郭應強, 蒙煒, 等. 全主動脈弓置換加支架象鼻手術治療A型主動脈夾層. 中國胸心血管外科臨床雜志, 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. 張明, 孫立忠, 劉永民, 等. 不同手術方式行全胸腹主動脈置換的臨床研究. 中華胸心血管外科雜志, 2012, 28(2):68-71.
8. 程力劍, 孫立忠, 朱俊明, 等. 63例全胸腹主動脈置換術患者中期結果分析. 中國胸心血管外科臨床雜志, 2009, 16(5):339-343.
9. 鄧美海, 區慶嘉. 胸-腹主動脈瘤手術中輔助方法的應用. 中國胸心血管外科臨床雜志, 1999, 6(3):86-88.
10. 賴顥, 王毓琳, 王春生, 等. 分期全主動脈置換術治療主動脈夾層動脈瘤. 中國臨床醫學, 2012, 19(4):352-353.
11. 孫立忠, 程力劍, 朱俊明, 等. 常溫非體外循環下全胸腹主動脈置換術. 中華胸心血管外科雜志, 2011, 27(12):705-711.
12. 黃福華, 陳鑫, 石開虎, 等. 胸腹主動脈瘤手術中重建肋間動脈的簡易方法. 心肺血管病雜志, 2009, 28(2):78-81.
13. 鄒以席, 黃方炯, 孫東, 等. 胸腹主動脈瘤手術中腦脊液引流對脊髓的保護作用. 中國胸心血管外科臨床雜志, 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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