摘要目的 探究不同原发继发破口面积的比对急性Stanford A型主动脉夹层患者围术期预后及早期假腔闭合率的影响.方法 纳入本中心2014年11月至2016年12月收治的急性Stanford A型主动脉夹层患者120例,根据原发与继发破口面积比(proximal and distal tear size ratio,PDTSR)分为A组35例(PDTSR≥2),B组44例(1/2＜ PDTSR ＜2)和C组41例(PDTSR≤1/2),分析比较3组患者围术期死亡及并发症以及孙氏手术后3个月假腔闭合率.结果 A组术前死亡(37.1％)明显高于B组(2.3％)和C组(2.4％),P ＜0.001;A组术前并发症发生率较B组和C组增高,但差异无统计意义;A组术后呼吸机辅助时间＞5天,明显高于B组和C组(P =0.006);术后3个月假腔闭合率A组(85.0％)较B组(65.0％)和C组(72.7％)有增高趋势,但差异无统计学意义(P =0.263).Logistic多因素回归分析提示原发破口面积显著大于继发破口面积是患者术前死亡的独立危险因素.结论 原发破口显著大于继发破口的Stanford A型主动脉夹层患者术前死亡风险明显增高,但此类高风险患者孙氏手术后早期假腔闭合效果理想,可从及时有效的手术治疗中明显获益.

abstractsObjective To retrospectively analyze perioperative and early outcomes after Sun's procedure of type A aortic dissection patients with different tear size ratia.Methods To retrospectively analyze the general information of 120 patients with acute Stanford type A aortic dissectiontreatedin our center from November 2014 to December 2016.Patients were divided into three group according to proximal and distal tear sizeratio(PDTSR):35 patients in Group A(PDTSR≥2),44 patients in Group B (1/2 ＜ PDTSR ＜ 2)and 41 patients in Group C (PDTSR ≤ 1/2).Retrospectively reviewed the data of perioperativeand follow-up period.Results Preoperative mortality was significantly higher in Group A (37.1％ vs.2.3％ vs.2.4％;P ＜ 0.001).Preoperative morbidity higher in Group A,but there was no significant difference.Ventilator support of duration ＞ 5 days in Group A is significantly higher in Group A (P =0.006).Three-month closure rate of false lumen was higher in Group A (85.0％ vs.65.0％ vs.72.7 ％,P =0.263).Proximal tear significantly larger than distal tear was found associated with preoperative death in logistic regression analysis.Conclusion Acute type A aortic dissection patients with larger proximal tear size need more urgent surgery to fix the dissection.Sun's procedure was an effective way to cure type A aortic dissection,while patients with relatively larger distal tears need more strict postoperative follow-up.