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目的:观察Stanford A型主动脉夹层患者双侧肾动脉受累的CT血管成像(CTA)影像解剖学分型，并探讨不同分型患者术后急性肾功能损伤(AKI)的差异。方法:回顾性研究。纳入2010年1月—2017年12月中国医学科学院阜外医院外科1 331例Stanford A型主动脉夹层患者影像及临床资料，其中男1 008例、女323例，年龄27～66岁，均行胸腔入口到股骨头的轴向CT平扫及主动脉CTA检查。根据主动脉CTA表现，将一侧肾动脉受累情况分为T型(真腔型)、F型(假腔型)、B型(双腔型)、C型(挤压型)、S型(三明治型)，共5型；据此，双侧的肾动脉受累情况可分为TT型、TF型、TB型、BB型、BF型、CF型、TS型等7型。分析并比较肾动脉受累不同影像解剖分型患者术后AKI发生率、持续性肾脏替代治疗(CRRT)使用率和患者术后早期(术后<30 d)死亡率。结果:本组1 331例Stanford A型主动脉夹层患者双侧肾动脉受累解剖分型为TT型者575例、TF型352例、TB型198例、BB型17例、BF型30例、CF型84例、TS型75例，各解剖分型患者术后AKI的发生率分别为14.61%(84/575)、22.44%(79/352)、36.36%(72/198)、9/17、40.0%(12/30)、65.48%(55/84)、36.0%(27/75)，术后CRRT使用率为3.48%(20/575)、6.82%(24/352)、12.12%(24/198)、3/17、10.00%(3/30)、32.14%(27/84)、9.33%(7/75)，早期死亡率为4.17%(24/575)、4.26%(15/352)、11.11%(22/198)、2/17、13.33%(4/30)、17.86%(15/84)、5.33%(4/75)，7种分型间AKI发生率、CRRT使用率及早期死亡率比较，差异均有统计学意义(n P值均<0.01)；其中，CF型各项指标发生率均为最高，其次为BB型和BF型。n 结论:Standford A型主动脉夹层肾动脉受累的不同解剖分型在AKI发生率、CRRT使用率及早期死亡率存在差异，其中CF型上述3个观察指标均较其他分型高。“,”Objective:A study was conducted to observe the CT angiography imaging anatomy of renal artery involvement in Stanford type A aortic dissection and to explore the clinical value of this classification system.Methods:Data of 1331 patients with Stanford type A aortic dissection who underwent surgery at Department of Surgery of Fuwai Hospital of Chinese Academy of Medical Science were collected from January 2010 to December 2017. According to the aortic CT plane scan, the anatomical involvement of one side of the renal artery can be divided into the following five cases: type T, true lumen involved; type F false lumen involved; type B, both lumens involved; type C, crushed intimal flap; and type S, sandwich model. According to the actual CT tomographic observation statistics, bilateral renal artery involvement can be classified as TT, TF, TB, BB, BF, CF, and TS types. The incidences of postoperative AKI and CRRT and the early postoperative mortality of patients with bilateral renal artery involvement were analyzed and compared.Results:A total of 1331 Stanford type A aortic dissection patients with bilateral renal artery involvement were grouped according to anatomic classification, as follows: 575 patients had TT type; 352 patients had TF type; 198 patients had TB type; 17 patients had BB type; 30 patients had BF type; 84 patients had CF type; and 75 patients had TS type. The incidences of postoperative AKI of the TT, TF, TB, BB, BF, CF, and TS types were 14.61%(84/575), 22.44%(79/352), 36.36%(72/198), 9/17, 40.0%(12/30), 65.48%(55/84), and 36.0%(27/75), respectively. The incidences of postoperative CRRT of the TT, TF, TB, BB, BF, CF, and TS types were 3.48%(20/575), 6.82%(24/352), 12.12%(24/198), 3/17, 10.00%(3/30), 32.14%(27/84), and 9.33%(7/75), respectively. The early mortality of the TT, TF, TB, BB, BF, CF, and TS types were 4.17%(24/575), 4.26% (15/352), 11.11%(22/198), 2/17, 13.33%(4/30), 17.86%(15/84), and 5.33%(4/75), respectively. Statistically significant differences in the incidence of AKI, CRRT use, and early mortality were found among the various subtypes (all n P values<0.01). The incidence of CF type was the highest, followed by BB and BF types.n Conclusions:Statistically differences in the incidence of AKI, CRRT, and early mortality were found among the anatomical types of renal artery involvement in Stanford type A aortic dissection. The incidences of the above three observation indicators were highest in the CF type, followed by the BB and BF types.