保留头臂动脉的孙氏手术（附4例报告）

Brachiocephalic artery conserved Sun’s procedure（with a report of 4 cases）

摘要:

目的：总结采用保留头臂动脉的孙氏手术治疗头臂动脉未受累及的复杂型Stanford A型主动脉夹层的临床经验。方法：2013年2月至2013年11月为4例患者实施该手术，患者均为男性，年龄（45±16.02）岁，急性期手术2例，慢性期手术2例。均在深低温停循环，右腋动脉插管选择性脑灌注下手术。同期行升主动脉置换术3例，无冠窦及升主动脉置换术1例。结果：体外循环时间（220±58.21） min，主动脉阻断时间（109.25±52.87） min，深低温停循环选择性脑灌注时间（53.75±29.24） min。术后24 h胸腔心包引流量（337.5±202.22） ml。无开胸止血，无昏迷或截瘫，1例术后因呼吸功能不全行无创呼吸机通气。4例患者均康复出院，出院前复查CT：升主动脉及主动脉弓人工血管无扭曲，胸降主动脉内支架血管复张、贴壁良好，夹层真腔扩大，假腔闭合或缩小。术后随访1～10个月，患者恢复良好，无死亡及再次手术。结论：保留头臂动脉的孙氏手术治疗头臂动脉未受累及的复杂型Stanford A型主动脉夹层安全、有效、简便。

Abstract:

Objective：To summarize the experiences of brachiocephalic artery conserved Sun’s procedures for the patients with bra－chiocephalic artery uninvolved complicated Stanford type A aortic dissection. Methods：From February 2013 to November 2013，4 pa－tients of innominate artery uninvolved complicated Stanford A aortic dissection were operated in our hospital. They were all males，with an average age of （45±16.02） years old. Two patients were operated in emergence while two others not. Right axillary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion was utilized when deep hypothermic circu－latory arrest. Replacement of ascending aorta was carried out for three patients，while replacement of noncoronary sinus and ascending aorta for one. Results：Cardiopulmonary bypass time was （220±58.21） min，the aortic occlusion time was （109.25±52.87） min，and selected cerebral perfusion time when deep hypothermic circulatory arrest was （53.75±29.24） min. The drainage in 24 h was （337.5±202.22） ml after operation. No coma and paraplegia was found in this group. No patient was re-operated. One patient suffered from noninvasive mechanical ventilation because of respiratory insufficiency. All patients were discharged home. CT exams before discharge confirmed a good result of surgery. All patients were follow-up for 1-10 months. They recovered well and no death occurred. Conclusion：Brachiocephalic artery conserved Sun’s procedures is good and safe for the patients with brachiocephalic artery uninvolved complicated Stanford A aortic dissection.