摘要目的:探索急性A型主动脉夹层累及颈动脉导致颈动脉重度狭窄或闭塞的外科治疗策略。方法:2019年1月至2023年3月，共29例急性A型主动脉夹层累及颈动脉导致颈动脉重度狭窄或闭塞患者纳入研究。所有患者均为急诊手术，处理主动脉夹层同期术中颈部切口置换单侧或者双侧颈总动脉。其中男19例，年龄(49.57±2.14)岁。15例术前脑CT提示异常，术前短暂性神经障碍5例，晕厥1例。结果:主动脉根部行升主置换10例，Bentall术18例，Wheat术1例。弓部操作部分弓置换3例，孙氏手术26例。单纯左颈总动脉置换6例，单纯右颈总动脉置换19例，双颈总动脉置换4例。术中停循环期间脑保护措施采用单侧脑灌注24例，双侧脑灌注5例。手术时间(7.6±0.3)h，体外循环(196.3±8.7)min，主动脉阻断(113.2±6.4)min，低流量通气12(5.0～16.5)min，最低温度(26.3±0.4)℃。1例院内死亡。术后新发神经功能障碍3例，其中永久性神经功能损伤1例，短暂性神经功能损伤2例(包括谵妄1例，短暂性意识不清1例)。结论:急性A型主动脉夹层累及颈动脉导致颈动脉重度狭窄或闭塞术中一期颈部切口行颈动脉替换是一种安全可靠的手术方法。

abstractsObjective:To explore surgical strategies for acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries.Methods:From January 2019 to March 2023, a total of 29 patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries were included in the study. All patients underwent emergency surgery, with simultaneous intraoperative neck incision and replacement of the unilateral or bilateral carotid arteries. Among them, there were 19 males with a mean age of(49.57±2.14)years old. Preoperative brain CT indicated abnormalities in 15 cases, transient neurological dysfunction occurred in 5 cases, and syncope in 1 case.Results:Procedures included ascending aorta replacement in 10 cases, Bentall procedure in 18 cases, and Wheat procedure in 1 case. Arch operations involved partial arch replacement in 3 cases and Sun’s procedure in 26 cases. Simple left carotid artery replacement was performed in 6 cases, simple right carotid artery replacement in 19 cases, and bilateral carotid artery replacement in 4 cases. Cerebral protection measures during circulatory arrest included unilateral cerebral perfusion in 24 cases and bilateral cerebral perfusion in 5 cases. The mean operation time was(7. 6±0. 3) h, with a mean cardiopulmonary bypass time of(196. 3±8. 7) min, aortic cross-clamp time of(113.2±6.4) min, ischemic time 12(5-16.5) min, and lowest temperature of(26.3±0.4)°C. One patient experienced in-hospital mortality. Postoperatively, new neurological dysfunction occurred in 2 cases, including 1 case with coma and permanent neurological deficit.Conclusion:In patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries, simultaneous carotid artery replacement via neck incision during aortic surgery is a safe and reliable surgical approach.