• 上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院?心血管外科， 上海?200127;

目的　探討Stanford A型急性主動(dòng)脈夾層累及根部的手術(shù)治療策略。　方法　上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院自2005年1月至2010年12月，共62例Stanford A型急性主動(dòng)脈夾層累及根部的患者接受手術(shù)治療。根據(jù)對(duì)夾層近心端采用的不同手術(shù)處理方法分為3組，A組：28例，男20例、女 8例，年齡（45.2±15.6）歲；行主動(dòng)脈瓣交界懸吊＋升主動(dòng)脈置換術(shù)； B組：10例，男7例、女3例，年齡（44.6±14.9）歲；行部分竇部成形＋升主動(dòng)脈置換術(shù)； C組：24例，男 17例、女7例，年齡（46.2±15.6）歲；行Bentall手術(shù)。比較分析3組患者的臨床效果。　結(jié)果　圍術(shù)期死亡6例，病死率為9.67% （6/62）。共隨訪54例，隨訪（27.3±15.7） 個(gè)月。隨訪期間死亡2例，1例死亡原因不明，1例死于肺癌。A組1例患者術(shù)后6個(gè)月復(fù)查CT顯示主動(dòng)脈竇部假性動(dòng)脈瘤。C組體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間明顯較A組和B組長 ［（274±97） min vs. （194±65） min、 （210±77） min，t=22.482， 30.419，P=0.002，0.122； （150±56） min vs. （97±33） min、 （105±46） min， t=12.630，17.089，P=0.000，0.034］ 。3組患者的住院死亡率（t=1.352，P=0.516）及圍術(shù)期二次開胸、急性腎損傷、神經(jīng)系統(tǒng)并發(fā)癥發(fā)生情況差異無統(tǒng)計(jì)學(xué)意義（t=0.855，0.342，2.281；P=0.652，0.863，0.320）?！〗Y(jié)論　針對(duì)急性主動(dòng)脈夾層病變累及根部的手術(shù)治療可以采用主動(dòng)脈瓣交界懸吊＋升主動(dòng)脈置換術(shù)、部分竇部成形＋升主動(dòng)脈置換術(shù)和Bentall手術(shù)等方法，并各有其優(yōu)缺點(diǎn)。掌握每種方法的手術(shù)指征，靈活運(yùn)用，可以獲得滿意的臨床效果。

引用本文： 胡振雷,薛松,徐根興,黃日太,劉沙,連鋒. 急性主動(dòng)脈夾層累及根部的外科治療. 中國胸心血管外科臨床雜志, 2012, 19(4): 381-384. doi: 復(fù)制

1. 　Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection：Perspectives from the international registry of acute aortic dissection. Eur J Vasc Endovasc Surg, 2009, 37 （2）：149-59.
2. 　Moon MR. Approach to the treatment of aortic dissection. Surg Clin North Am, 2009, 89 （4）：869-893.
3. 　Rylski B, Suedkamp M, Beyersdorf F, et al. Outcome after surgery for acute aortic dissection type A in patients over 70 years： data analysis from the German Registry for Acute Aortic Dissection Type A （GERAADA）. Eur J Cardiothorac Surg, 2011, 40 （2）：435-440.
4. 　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.
5. 　Hata H，Takano H，Matsumiya G，et a1. Late complications of gelatin resorcin formalin glue in the repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 83 （5）：1621-1626.
6. 　Suzuki S, Masuda M?. An update on surgery for acute type A aortic dissection： aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39 （4）：281-289.
7. 　Concistre G, Casali G, Santaniello E, et al. Reoperation after surgical correction of acute type A aortic dissection：risk factor analysis. Ann Thorac Surg, 2012, 93 （2）：450-455.
8. 　Itoh M, Okazaki Y, Ikeda K, et al. Partial aortic root remodeling for fistula between the non-coronary sinus and the right atrium. Heart Lung Circ, 2008, 17 （3）：243-263.
9. 　Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aorticdissection. Ann Thorac Surg, 2000, 70 （4）： 1227-1233.
10. 　Louis-Mathieu Stevens, Joren C. Madsen, Eric M. Isselbacher, et al. Surgical management and long-term outcomes for acute ascending　aortic dissection. J Thorac Cardiovasc Surg, 2009, 138 （6）：.
11. 　Halstead JC, Spielvogel D, Dieter MM, et al. Composite aortic root replacement in acute type A dissection：time to rethink the indications? Eur J　Cardiothorac Surg, 2005, 27 （4）：.
12. 　Van Putte BP, Ozturk S, Siddiqi s, et al. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg, 2012, 93 （2）：503-509.
13. 　Tanaka M, Kimura N, Yamaguchi A, et al. In-hospital and long-term results of surgery for acute type A aortic dissection：243 consecutive patients. Ann Thorac Cardiovasc Surg, 2012, 18 （1）：18-23.
14. 　Zizza A, Pano M, Zaccaria S, et al. Outcome of acute type A aortic dissection：single-center experience from 1998 to 2007. J Prev Med Hyg, 2009, 50 （3）：152-158.
15. 　Borghetti V, Dionisi D, Principi M, et al. Aortic valve re-implantation technique with Gelweave Valsalva prosthesis：safety, reproducibility and pitfalls of a geometric reconstruction. J Cardiovasc Med, 2009, 10 （11）：834-841.
16. 　Settepani F, Bergonzini M, Barbone A, et al. Reimplantation valve-sparing aortic root replacement with the Valsalva graft：what have we learnt after 100 cases ? Interact Cardiovasc Thorac Surg, 2009, 9 （1）：113-116.
17. 　Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation （David I）. Eur J Cardiothorac Surg, 2012, 41 （1）：56-62.
18. 　 Kallenbach K, Pethig K, Leyh RG, et al. Acute dissection of the ascending aorta： first results of emergency valve sparing aortic root reconstruction. Eur J Cardiothorac Surg, 2002, 22 （2）： 218-222.
19. 　Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J　Cardiothorac Surg, 2010, 37 （3）：691-696.
20. 　Kimura N, Tanaka M, Kawahito K, et al. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2008, 136 （5）：1160-1166.
21. -633.
22. -1357.
  1. 1. 　Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection：Perspectives from the international registry of acute aortic dissection. Eur J Vasc Endovasc Surg, 2009, 37 （2）：149-59.
  2. 2. 　Moon MR. Approach to the treatment of aortic dissection. Surg Clin North Am, 2009, 89 （4）：869-893.
  3. 3. 　Rylski B, Suedkamp M, Beyersdorf F, et al. Outcome after surgery for acute aortic dissection type A in patients over 70 years： data analysis from the German Registry for Acute Aortic Dissection Type A （GERAADA）. Eur J Cardiothorac Surg, 2011, 40 （2）：435-440.
  4. 4. 　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.
  5. 5. 　Hata H，Takano H，Matsumiya G，et a1. Late complications of gelatin resorcin formalin glue in the repair of acute type A aortic dissection. Ann Thorac Surg, 2007, 83 （5）：1621-1626.
  6. 6. 　Suzuki S, Masuda M?. An update on surgery for acute type A aortic dissection： aortic root repair, endovascular stent graft, and genetic research. Surg Today, 2009, 39 （4）：281-289.
  7. 7. 　Concistre G, Casali G, Santaniello E, et al. Reoperation after surgical correction of acute type A aortic dissection：risk factor analysis. Ann Thorac Surg, 2012, 93 （2）：450-455.
  8. 8. 　Itoh M, Okazaki Y, Ikeda K, et al. Partial aortic root remodeling for fistula between the non-coronary sinus and the right atrium. Heart Lung Circ, 2008, 17 （3）：243-263.
  9. 9. 　Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aorticdissection. Ann Thorac Surg, 2000, 70 （4）： 1227-1233.
  10. 10. 　Louis-Mathieu Stevens, Joren C. Madsen, Eric M. Isselbacher, et al. Surgical management and long-term outcomes for acute ascending　aortic dissection. J Thorac Cardiovasc Surg, 2009, 138 （6）：.
  11. 11. 　Halstead JC, Spielvogel D, Dieter MM, et al. Composite aortic root replacement in acute type A dissection：time to rethink the indications? Eur J　Cardiothorac Surg, 2005, 27 （4）：.
  12. 12. 　Van Putte BP, Ozturk S, Siddiqi s, et al. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg, 2012, 93 （2）：503-509.
  13. 13. 　Tanaka M, Kimura N, Yamaguchi A, et al. In-hospital and long-term results of surgery for acute type A aortic dissection：243 consecutive patients. Ann Thorac Cardiovasc Surg, 2012, 18 （1）：18-23.
  14. 14. 　Zizza A, Pano M, Zaccaria S, et al. Outcome of acute type A aortic dissection：single-center experience from 1998 to 2007. J Prev Med Hyg, 2009, 50 （3）：152-158.
  15. 15. 　Borghetti V, Dionisi D, Principi M, et al. Aortic valve re-implantation technique with Gelweave Valsalva prosthesis：safety, reproducibility and pitfalls of a geometric reconstruction. J Cardiovasc Med, 2009, 10 （11）：834-841.
  16. 16. 　Settepani F, Bergonzini M, Barbone A, et al. Reimplantation valve-sparing aortic root replacement with the Valsalva graft：what have we learnt after 100 cases ? Interact Cardiovasc Thorac Surg, 2009, 9 （1）：113-116.
  17. 17. 　Shrestha M, Baraki H, Maeding I, et al. Long-term results after aortic valve-sparing operation （David I）. Eur J Cardiothorac Surg, 2012, 41 （1）：56-62.
  18. 18. 　 Kallenbach K, Pethig K, Leyh RG, et al. Acute dissection of the ascending aorta： first results of emergency valve sparing aortic root reconstruction. Eur J Cardiothorac Surg, 2002, 22 （2）： 218-222.
  19. 19. 　Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J　Cardiothorac Surg, 2010, 37 （3）：691-696.
  20. 20. 　Kimura N, Tanaka M, Kawahito K, et al. Influence of patent false lumen on long-term outcome after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2008, 136 （5）：1160-1166.
  21. 21. -633.
  22. 22. -1357.