中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2012年
4期
212-214
,共3页
刘巍%孙立忠%朱俊明%刘永民%陈雷%里程楠%乔志钰%胡海瓯%杨祎%郭世超%邢晓燕
劉巍%孫立忠%硃俊明%劉永民%陳雷%裏程楠%喬誌鈺%鬍海甌%楊祎%郭世超%邢曉燕
류외%손립충%주준명%류영민%진뢰%리정남%교지옥%호해구%양의%곽세초%형효연
主动脉%动脉瘤,夹层%心脏外科手术%胸主动脉%胸腹主动脉置换术
主動脈%動脈瘤,夾層%心髒外科手術%胸主動脈%胸腹主動脈置換術
주동맥%동맥류,협층%심장외과수술%흉주동맥%흉복주동맥치환술
Aorta%Aneuysm,dissecting%Cardiac surgical procedures%Thoracoabdominal aorta%Thoracoabdominal aorta replacement
目的 探讨孙氏手术后远端胸腹主动脉夹层动脉瘤的手术方式和治疗经验.方法 2009年6月至2011年5月,13例孙氏手术后胸腹主动脉夹层动脉瘤患者接受胸腹主动脉置换手术治疗.男11例,女2例；年龄28 ～ 58岁,平均39.3岁.均为Stanford A型主动脉夹层、孙氏手术后患者.病因为马方综合征10例,高血压3例.全组均为CrawfordⅡ型胸腹主动脉夹层动脉瘤.“象鼻”支架以远胸腹主动脉最大直径4.0～8.0cm,平均(5.78±1.00) cm.经胸腹联合切口、腹膜外入路,采用四分支人工血管翻转、分段阻断技术行胸腹主动脉置换术.采用深低温停循环技术7例,常温非体外循环技术6例.结果 无手术早期死亡.12例患者治愈出院.采用深低温停循环技术的患者中1例术后截瘫,后出现败血症、伪膜性肠炎、呼吸衰竭,于术后102天死亡.1例出现缺血、缺氧脑病,脱水治疗6天后清醒、治愈出院.全组患者术后胸腹主动脉螺旋CT复查示人工血管通畅、无扭曲、无假性动脉瘤.3例患者肋间动脉分支闭塞,但无脊髓缺血症状.患者均随访1～ 24个月,平均(9.6±2.1)个月.随访期间患者人工血管通畅,无假性动脉瘤形成,无脑部、脊髓及腹腔脏器等缺血表现.结论 孙氏手术能降低手术难度；减少并发症.常温非体外循环下,采用四分支人工血管翻转、分段阻断技术可以简化胸腹主动脉置换术,减少并发症.
目的 探討孫氏手術後遠耑胸腹主動脈夾層動脈瘤的手術方式和治療經驗.方法 2009年6月至2011年5月,13例孫氏手術後胸腹主動脈夾層動脈瘤患者接受胸腹主動脈置換手術治療.男11例,女2例；年齡28 ～ 58歲,平均39.3歲.均為Stanford A型主動脈夾層、孫氏手術後患者.病因為馬方綜閤徵10例,高血壓3例.全組均為CrawfordⅡ型胸腹主動脈夾層動脈瘤.“象鼻”支架以遠胸腹主動脈最大直徑4.0～8.0cm,平均(5.78±1.00) cm.經胸腹聯閤切口、腹膜外入路,採用四分支人工血管翻轉、分段阻斷技術行胸腹主動脈置換術.採用深低溫停循環技術7例,常溫非體外循環技術6例.結果 無手術早期死亡.12例患者治愈齣院.採用深低溫停循環技術的患者中1例術後截癱,後齣現敗血癥、偽膜性腸炎、呼吸衰竭,于術後102天死亡.1例齣現缺血、缺氧腦病,脫水治療6天後清醒、治愈齣院.全組患者術後胸腹主動脈螺鏇CT複查示人工血管通暢、無扭麯、無假性動脈瘤.3例患者肋間動脈分支閉塞,但無脊髓缺血癥狀.患者均隨訪1～ 24箇月,平均(9.6±2.1)箇月.隨訪期間患者人工血管通暢,無假性動脈瘤形成,無腦部、脊髓及腹腔髒器等缺血錶現.結論 孫氏手術能降低手術難度；減少併髮癥.常溫非體外循環下,採用四分支人工血管翻轉、分段阻斷技術可以簡化胸腹主動脈置換術,減少併髮癥.
목적 탐토손씨수술후원단흉복주동맥협층동맥류적수술방식화치료경험.방법 2009년6월지2011년5월,13례손씨수술후흉복주동맥협층동맥류환자접수흉복주동맥치환수술치료.남11례,녀2례；년령28 ～ 58세,평균39.3세.균위Stanford A형주동맥협층、손씨수술후환자.병인위마방종합정10례,고혈압3례.전조균위CrawfordⅡ형흉복주동맥협층동맥류.“상비”지가이원흉복주동맥최대직경4.0～8.0cm,평균(5.78±1.00) cm.경흉복연합절구、복막외입로,채용사분지인공혈관번전、분단조단기술행흉복주동맥치환술.채용심저온정순배기술7례,상온비체외순배기술6례.결과 무수술조기사망.12례환자치유출원.채용심저온정순배기술적환자중1례술후절탄,후출현패혈증、위막성장염、호흡쇠갈,우술후102천사망.1례출현결혈、결양뇌병,탈수치료6천후청성、치유출원.전조환자술후흉복주동맥라선CT복사시인공혈관통창、무뉴곡、무가성동맥류.3례환자륵간동맥분지폐새,단무척수결혈증상.환자균수방1～ 24개월,평균(9.6±2.1)개월.수방기간환자인공혈관통창,무가성동맥류형성,무뇌부、척수급복강장기등결혈표현.결론 손씨수술능강저수술난도；감소병발증.상온비체외순배하,채용사분지인공혈관번전、분단조단기술가이간화흉복주동맥치환술,감소병발증.
Objective To explore the surgical techniques and clinical experiences in treating thoracoabdominal aorta dissecting aneurysm following Sun's procedure.Methods From June 2009 to May 2011,thoracoabdominal aorta replacement was performed in thirteen patients with thoracoabdominal aorta dissecting aneurysm following Sun's procedure in Beijing Anzhen Hospital.Among which,eleven were male,and two were female with a mean age 39.3 years (28 -58 years).All cases were Stanford A aortic dissection,and were underwent Sun's Procedure.The pathogeny of the dissection,ten were Marfan's syndrome,and three were hypertension.Thoracoabdominal aorta dissecting aneurysms were all Crawford type Ⅱ,with the diameter( 5.78 ± 1.00 )cm (4.0 -8.0 cm).All the procedures were performed through combined thoracoabdominal incision via the retroperitoneal approach.And thoracoabdominal aorta was replaced by a tetrafurcate graft with short-time interval circulatory arrest.24 - 30 mm tetrafurcate grafts were selected in all patients.The main graft of the tetrafurcate graft was anastomosed to the "elephant truck" stent graft.Visceral arteries were joined into a patch and were anastomosed to the other end of the main graft.T6 to T12 intercostal arteries were reconstructed by an 8 mm sidearm.Another 8 mm sidearm was anastomosed to the left renal artery.Both 10 mm sidearms were anastomosed to iliac arteries.Among which,seven were underwent by profound hypothermia with circulatory arrest,and six were underwent off pump with normal temperature.Results No early death.Twelve patients were cured and discharged from hospital.Seven patients were underwent profound hypothermia with circulatory arrest.Among which,one patient had paraplegia,sepsis,pseudomembranous colitis,respiratory failure,and died on 102-day after operation.Another one patient had neurological dysfunction and was cured after six-day's dehydrated treatment.The UFCT showed that the tetrafurcate graft was unobstructed,no distortion,no pseudoaneurysms in all patients.The branch to intercostal arteries was obstructed in three cases,but there were no spinal cord ischemia complications.The mean duration of follow-up was (9.6 ±2.1 ) months (range,1 -24 months),with a follow-up rate of 100％.All the tetrafurcate graft were very well,no obstruction,no distortion and no pseudoaneurysms.There were no cerebral,spiral cord and abdominal viscera ischemia complications in all patients.Conclusion Thoracoabdominal aorta replacement after Sun's procedure is simple,and it is helpful to reduce complications.Following Sun's procedure,using tetrafurcate graft with short-time interval circulatory arrest and off pump technique in thoracoabdominal aorta replacement is simple,and it is helpful to reduce complications.
