CAJ | 학술논문

目的总结主动脉夹层病人行人工血管置换同时术中植入血管内支架(即"杂交手术")的外科经验.方法主动脉夹层6例中急性Standford A型4例,其中破口分别在升主动脉2例、降主动脉1例,升降主动脉均有破口1例.行升主动脉并全弓置换同时术中于降主动脉真腔内置入血管内支架(同时行主动脉瓣成型2例、Bentall手术1例);慢性StaMford B型主动脉夹层2例,均为介入无法完成者,破口较大、均在降主动脉起始部、左锁骨下动脉下方,行近端降主动脉置换同时术中于远端降主动脉真腔内置入血管内支架.术后2周及3个月复查全主动脉螺旋CT,了解胸腹主动脉、人工血管及血管内支架情况.结果所有病人手术成功,体外循环时间38～228 min(平均92 min).Standford A型夹层升主动脉阻断118～186 min(平均136min)、选择性脑灌注33～68min(平均49min);Standford B型夹层:1例在上、下半身分别停循环22、28 min下完成手术,另1例常温下不停循环、保持下半身灌注完成手术.术后恢复顺利,治愈出院.术后2周及3个月复查主动脉螺旋CT示人工血管血流通畅,血管内支架无内瘘及移位,支架远端主动脉真腔扩大、假腔明显缩小.结论对于夹层撕裂范围广泛、多破口的主动脉夹层病人,行近端夹层动脉瘤切除、人工血管置换同时在远端真腔内植入血管内支架,是一种安全、有效、经济的手术方法.
목적 총결주동맥협층병인행인공혈관치환동시술중식입혈관내지가(즉"잡교수술")적외과경험.방법 주동맥협층6례중급성Standford A형4례,기중파구분별재승주동맥2례、강주동맥1례,승강주동맥균유파구1례.행승주동맥병전궁치환동시술중우강주동맥진강내치입혈관내지가(동시행주동맥판성형2례、Bentall수술1례);만성StaMford B형주동맥협층2례,균위개입무법완성자,파구교대、균재강주동맥기시부、좌쇄골하동맥하방,행근단강주동맥치환동시술중우원단강주동맥진강내치입혈관내지가.술후2주급3개월복사전주동맥라선CT,료해흉복주동맥、인공혈관급혈관내지가정황.결과 소유병인수술성공,체외순배시간38～228 min(평균92 min).Standford A형협층승주동맥조단118～186 min(평균136min)、선택성뇌관주33～68min(평균49min);Standford B형협층:1례재상、하반신분별정순배22、28 min하완성수술,령1례상온하불정순배、보지하반신관주완성수술.술후회복순리,치유출원.술후2주급3개월복사주동맥라선CT시인공혈관혈류통창,혈관내지가무내루급이위,지가원단주동맥진강확대、가강명현축소.결론 대우협층시렬범위엄범、다파구적주동맥협층병인,행근단협층동맥류절제、인공혈관치환동시재원단진강내식입혈관내지가,시일충안전、유효、경제적수술방법.
Objective To summary the experience of concomitant thoratic aotic replacement and endoluminal stent grafting (socalled'Hybrid technique') for aortic dissection. Methods Four patients with acute Standford type A dissection (dissection located inascending aortic in 2 cases, descending aortic in 1, both ascending and descending aortic in 1 ) received ascending aortic and total aor-tic arch replacement and endoluminal stent grafting. Two cases with chronic Standford type B dissection, located in descending aortic,received descending aortic replaoernent and endoluminal stent grafting. Enhanced electric beam computed tomography (EBCT) wasperformed in each patient at two weeks and three months after surgery to check up the postoperative course. Results All patients suc-cessfully recovered from surgery procedure, time of cardiopulmonary bypass was 38-228 min (mean 92 min), arrest time of ascendingaortic was 118-186 min (mean 136 min) in Standford type A dissection, which time of selective cerebral perfusion was 33-68 min(mean 49 min). Tune of circulation arrest in Standford type B was 22 - 28 min. All patients were discharged from hospital. EBCT in-dicated smooth bloodstream in prosthesis, expansion of residual true lumen and reduction of false lumen, no inner-leak and no endo-stent dislocation at 2 weeks and 3 months after operation. Conclusion "Hybrid technique" (thoratic aotic replacement combined withendoluminal stent grafting) is a safe, effective and economic surgical treatment for complex aortic dissection.