作者：周越赟，王晓棣，黄福华

单位：

南京医科大学附属南京医院南京市第一医院心胸外科

Units：

Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital Nanjing Medical University/Nanjing First Hospital, Nanjing 210006, China

关键词：

动脉瘤,夹层; 全弓置换术; 右半弓置换术; 治疗结果; 综述;

Keywords：

Aneurysm, dissecting; Total arch replacement; Hemiarch replacement; Treatment outcome; Review

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.124

Funds：

国家自然科学基金青年科学基金项目（81900417）

摘要：

急性DeBakeyⅠ型主动脉夹层是一种极为凶险的疾病，其发病后24 h内死亡率约为33%，发病后48 h内死亡率约为50%，发病后1周内死亡率约为80%，发病后1个月内死亡率高达95%。近年随着主动脉外科治疗理念和治疗方法不断完善，许多急性DeBakeyⅠ型主动脉夹层患者被及时救治。对于破口位于弓部、夹层假腔影响弓部三分支或破口位于降主动脉逆撕形成DeBakeyⅠ型主动脉夹层的患者，行全主动脉弓置换术基本已成为共识；但对于破口仅限于升主动脉且未影响弓部三分支的DeBakeyⅠ型主动脉夹层患者，其弓部处理方式（是否更换弓部及其三分支）尚有争议，即行全弓置换术与右半弓置换术尚有争议。本文主要综述了全弓置换术与右半弓置换术的手术方式及其治疗急性DeBakeyⅠ型主动脉夹层患者围术期效果、远期预后的研究进展，以期为急性DeBakeyⅠ型主动脉夹层患者治疗方式选择提供参考依据。

Abstract：

Acute DeBakey typeⅠaortic dissection is an extremely dangerous disease. The mortality rate is about 33% within 24 hours, 50% within 48 hours, 80% within 1 week and 95% within 1 month since the onset. With the progress of the concept and technic of aortic surgery, many patients with acute DeBakey typeⅠaortic dissection have been treated in time. For patients with intimal rupture in aortic arch, branch vessels involved by false lumen and retrograde DeBakey typeⅠaortic dissection, total arch replacement has become a common procedure. However, for patients with limited intimal rupture in ascending aorta and branch vessels were not involved, the treatment of aortic arch (whether to replace the branch vessels) , that is, total arch replacement or hemiarch replacement is still controversial. This article mainly reviews the surgical methods of total arch replacement and right hemiarch replacement and their perioperative effects and long-term prognosis in patients with acute DeBakey type I aortic dissection, in order to provide reference of treatment for this lethal disease.

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