PDF(Pubmed)
Abstract：
Acute type A aortic dissection is a severe cardiovascular disease characterized by rapid onset and high mortality. Traditionally, urgent open aortic repair is performed after admission to prevent aortic rupture and death. However, when combined with malperfusion syndrome, the low perfusion of the superior mesenteric artery can further lead to intestinal necrosis, significantly impacting the surgery\'s prognosis and potentially resulting in adverse consequences, bringing. This presents great significant challenges in treatment. Based on recent domestic and international research literature, this paper reviews the mechanism, current treatment approaches, and selection of surgical methods for poor organ perfusion caused by acute type A aortic dissection. The literature review findings suggest that central aortic repair can be employed for the treatment of acute type A aortic dissection with inadequate perfusion of the superior mesenteric artery. The superior mesenteric artery can be windowed and (/or) stented, followed by delayed aortic repair. Priority should be given to revascularization of the superior mesenteric artery, followed by central aortic repair. During central aortic repair, direct blood perfusion should be performed on the distal true lumen of the superior mesenteric artery, leading to resulting in favorable therapeutic outcomes. The research results indicate that even after surgical aortic repair, intestinal ischemic necrosis may still occur. In such cases, prompt laparotomy and necessary necrotic bowel resection are crucial for saving the patient\'s life.
摘要：
急性A型主动脉夹层是一种严重的心血管疾病，发病迅速，死亡率高。传统上,入院后进行紧急开放式主动脉修复术，以防止主动脉破裂和死亡。然而,当合并灌注不良综合征时，肠系膜上动脉的低灌注可进一步导致肠坏死,显着影响手术的预后，并可能导致不良后果，带来。这在治疗中提出了巨大的挑战。在国内外研究文献的基础上,本文回顾了这种机制，目前的治疗方法，急性A型主动脉夹层所致器官灌注不良的手术方法选择。文献综述结果表明，中央主动脉修复术可用于治疗肠系膜上动脉灌注不足的急性A型主动脉夹层。肠系膜上动脉可以开窗和（或）支架，其次是延迟的主动脉修复。应优先考虑肠系膜上动脉的血运重建,其次是中央主动脉修复术。在中央主动脉修复术中,应在肠系膜上动脉远端真腔进行直接血液灌注，导致良好的治疗结果。研究结果表明，即使在手术主动脉修复后，肠缺血性坏死仍可能发生。在这种情况下,及时的剖腹手术和必要的坏死性肠切除是挽救病人生命的关键。
