CAJ | 학술논문

目的比较手术治疗的效果,探讨不同手术方式行全胸腹主动脉替换术的适应证和具体手术方法,明确常温非体外循环下全胸腹主动脉替换的可行性和安全性.方法 2009年2月到2011年5月,46例CrawfordⅡ型胸腹主动脉瘤(thoracoabdominal aortic aneurysm,TAAA)患者行全胸腹主动脉替换术(total thoracoabdominal aortic aneurysm repair,tTAAAR).根据术式不同,分为深低温停循环tTAAAR(A)组15例和常温非体外循环tTAAAR(B)组31例.计数资料采用精确概率的x2检验和计数资料经正态性检验后采用t检验等统计学方法,比较了患者的术前、术中和术后ICU治疗情况以及围术期病死率、并发症发生率等.结果 A组和B组术后早期死亡(26.67％对3.20％,P=0.033)和一过性脑功能障碍发生率(33.30％对3.30％,P=0.018)差异有统计学意义.两组手术时间(P＜0.0001)、降主动脉阻断时间(P ＜0.0001),输注红细胞(P=0.013)差异亦有统计学意义.术前情况、内脏缺血时间、脊髓缺血时间、ICU治疗时间、带气管插管时间、脊髓损伤、肾功能不全等差异无统计学意义,P＞0.05.结论常温非体外循环全胸腹主动脉替换术安全、可靠.适应证为可在常温下建立降主动脉到髂动脉旁路循环的胸腹主动脉动脉瘤.肋间动脉重建是重要的脊髓保护手段.
목적 비교수술치료적효과,탐토불동수술방식행전흉복주동맥체환술적괄응증화구체수술방법,명학상온비체외순배하전흉복주동맥체환적가행성화안전성.방법 2009년2월도2011년5월,46례CrawfordⅡ형흉복주동맥류(thoracoabdominal aortic aneurysm,TAAA)환자행전흉복주동맥체환술(total thoracoabdominal aortic aneurysm repair,tTAAAR).근거술식불동,분위심저온정순배tTAAAR(A)조15례화상온비체외순배tTAAAR(B)조31례.계수자료채용정학개솔적x2검험화계수자료경정태성검험후채용t검험등통계학방법,비교료환자적술전、술중화술후ICU치료정황이급위술기병사솔、병발증발생솔등.결과 A조화B조술후조기사망(26.67％대3.20％,P=0.033)화일과성뇌공능장애발생솔(33.30％대3.30％,P=0.018)차이유통계학의의.량조수술시간(P＜0.0001)、강주동맥조단시간(P ＜0.0001),수주홍세포(P=0.013)차이역유통계학의의.술전정황、내장결혈시간、척수결혈시간、ICU치료시간、대기관삽관시간、척수손상、신공능불전등차이무통계학의의,P＞0.05.결론 상온비체외순배전흉복주동맥체환술안전、가고.괄응증위가재상온하건립강주동맥도가동맥방로순배적흉복주동맥동맥류.륵간동맥중건시중요적척수보호수단.
Objective To explore the safety and feasibility of performing total thoracoabdominal aortic aneurysm repair (tTAAAR) under normal thermia and non-cardiopulmonary bypass fashion by comparing surgical indications and details of different surgical strategies in tTAAAR.Methods From February 2009 to May 2011,46 consecutive patients with extensive Crawford Ⅱ thoracoabdominal aortic aneurysm (TAAA)underwent total thoracoabdominal aortic aneurysm repair( tTAAAR ) in An Zhen Hospital.The patients were divided into 2 groups ( A and B) according to their different surgical strategies.Patients in group A underwent total thoracoabdominal aortic aneurysm repair with deep hypothermia and circulatory arrest.Patients in group B underwent total thoracoabdominal aortic aneurysm repair in a normal thermia and non-circulatory bypass was performed via a combined left thoracoabdominal incision.After established the bypass from descending aorta to bilateral iliac arteries under normal thermia,the reestablishment of intercostal arteries and visceral arteries was followed with subsection circulatory arrest.The clinical results of these 2 groups were analyzed by SPSS 18.0.Results Patients in group A underwent total thoracoabdominal aortic aneurysm repair with deep hypothermia and circulatory arrest have higher mortality rate and transient nervous dysfunction rate (26.67％ vs 3.20％,P =0.033 ; 33.30％ vs 3.30％,P =0.018,respectively) than patients in group B underwent total thoracoabdominal aortic aneurysm repair in a normal thermia and non-circulatory bypass.Statistical significance was also observed between group A and circulatory arrest and group B in operation time,descending aortic clamping time,and transfusiori volume of red blood cells ( P ＜ 0.05 ).Average age,sex,pathological type,the maximal diameters of aneurysm,preoperative complications,visceral ischemia time,spinal cord ischemia time,ICU treatment time,intubation time,respiratory complications,plasma dosage,platelets dosage,RBC dosage,thoracotomy hemostatic,spinal cord injury,renal insufficiency were found no statistical significance(P ＞ 0.05 ) between two groups.In addition to death and paraplegia,the others were cured.Conclusion The normal thermia and non-cardiopulmonary bypass tTAAAR is a safe and feasible therapeutic strategy for TAAA patients.A bypass from descending aorta to iliac arteries can be built under normal thermia in TAAA patients,which is the indication of this new technique.Reestablishment of intercostal arteries is an important protective adjunct to avoid spinal cord injury.