摘要目的 总结直视支架象鼻手术治疗复杂型Stanford B型主动脉夹层的临床经验,探讨直视支架象鼻手术治疗Stanford B型夹层的手术指征和治疗效果.方法 2009年2月至2013年4月,50例复杂型Stanford B型主动脉夹层患者接受直视支架象鼻手术.根据患者发病时间的长短分为急性组(病程＜2周)和慢性组(病程≥2周),各有25例患者.比较两组患者术前、术中和术后资料.采用SPSS16.0统计分析软件,计量资料采用(x)±s的方式.两组患者的资料进行x2检验、方差分析和生存分析.结果 两组患者的术前资料差异无统计学意义;均在低温体外循环下完成手术,两组患者手术时间、术后气管插管时间、ICU治疗时间和术后住院时间差异均无统计学意义.患者术后均行CTA检查.同期行心脏手术15例次,血管外旁路手术16例次,无手术死亡.术后分别随访(33.76±16.15)个月和(42.44±14.08)个月.共失访2例,两组患者术后发生Ⅰ型内漏各2例.慢性组3例晚期死亡.两组主动脉事件发生率和晚期死亡差异无统计学意义.结论 直视支架象鼻手术治疗急/慢性复杂型Stanford B型主动脉夹层有效、可靠.需要二期手术以及合并需同期心脏手术的Stanford B型主动脉夹层是直视支架象鼻手术的最佳指征.预期寿命长且锚定区不足的Stanford B型夹层患者也适合做直视支架象鼻手术.患者是否处于急性期并非手术禁忌.

abstractsObjective To summarize the clinical results of open surgery for complex Stanford type B aortic dissection using stented elephant trunk technique, and to explore the indication and therapeutic effect of stented elephant trunk technique for the treatment of type B aortic dissection.Methods From Feb.2009 to Apr.2013,50 patients with complex type B aortic dissection underwent stented elephant trunk operation in our center.They were divided into two groups according to the period of the disease.Group Ⅰ is acute phase and group 2 is chronic phase.Each group contains 25 patients.The perioperative data of these 2 groups were recorded and analyzed using Chi-square test, ANOVA and Kaplan-Meire survival analysis by SPSS 16.0.Results The preoperative data of the two groups had no statistic differences.All the patients underwent the operation successfully with deep hypothermia circulatory arrest.Fifteen cases of concurrent cardiac operations and 16 cases of extra-anatomic operations were performed during the surgery.No operative deaths were found.The operative data, post-operative data and complications were also recorded and analyzed.No statistic differences were found.The morbidity of complications was low.The follow-up time was(33.76 ± 16.15) and(42.44 ± 14.08) months, respectively.The follow-up rate is 96％.Three late deaths were found in group 2.And each group has 2 cases of type Ⅰ endoleak.There were no statistical differences between two groups even though more late deaths and second aortic reintervention were found in group 2.Conclusion The open stented elephant trunk procedure is an effective and reliable therapeutic method for the treatment of complex type B aortic dissection.The most suitable indication of this surgery is type B aortic dissection with concomitant proximal heart diseases and patients with type B aortic dissection needed 2nd stage aortic surgery.Type B aortic dissection patients with short landing zone and with long life expectancy are suitable for this surgery.Acute type B aortic dissection is not the contraindication for open stented elephant trunk procedure.