CAJ | 학술논문

目的总结一期"杂交"主动脉弓部替换治疗累及主动脉弓的主动脉夹层及主动脉瘤的临床经验及早期随访结果,探讨一期"杂交"手术适应证.方法 2009年7月到2010年3月共22例累及主动脉弓的主动脉夹层或主动脉瘤病人在"杂交"手术室完成一期"杂交"主动脉弓替换手术.分别采用正中开胸,常温升主动脉至头臂动脉旁路移植,顺行主动脉弓部腔内覆膜支架置入术;和正中开胸,体外循环下升主动脉替换和(或)主动脉瓣置换和(或)冠脉旁路移植术,顺行主动脉弓部腔内覆膜支架置入术.比较体外循环组与同期采用传统深低温停循环手术行主动脉弓置换者的体外循环、主动脉阻断、ICU时间及血制品费用.结果全组均成功同期完成手术并置入覆膜支架.常温组支架直径(40.80±1.79)mm,支架长度(189.0±14.39)mm.1例病人术后第6天突然死亡,尸检证实为远端夹层破裂.体外循环组体外循环(132.0±24.00)min,主动脉阻断(49.18±12.09)min;支架直径(33.82±0.60)mm,支架长度(187.91±6.33)mm;1例病人术后5天CT发现纵隔积液,开胸探查证实为淋巴积液;1例病人术后12天死于呼吸衰竭及肾功能衰竭."杂交"体外循环组体外循环和主动脉阻断时间明显少于传统手术数组(P＜0.05);"杂交"手术者ICU天数明显少于传统手术组(P＜0.05);"杂交"手术者使用血制品量及费用也明显少于传统手术组(P＜0.05).全组随访12～20个月,平均(14.45±2.33)个月.随访者均生存且恢复正常生活,无明显不适.CT复查支架无移位及内漏.术后早期支架段假腔闭合率100%.术后3个月远端夹层无变化,部分病人远端夹层血栓形成.结论一期"杂交"主动脉弓替换手术安全、有效,能较传统手术明显缩短手术时间,减少手术创伤,缩短住院天数,减少输血,取得满意的早期治疗效果;但中、远期疗效尚须进一步随访.
목적 총결일기"잡교"주동맥궁부체환치료루급주동맥궁적주동맥협층급주동맥류적림상경험급조기수방결과,탐토일기"잡교"수술괄응증.방법 2009년7월도2010년3월공22례루급주동맥궁적주동맥협층혹주동맥류병인재"잡교"수술실완성일기"잡교"주동맥궁체환수술.분별채용정중개흉,상온승주동맥지두비동맥방로이식,순행주동맥궁부강내복막지가치입술;화정중개흉,체외순배하승주동맥체환화(혹)주동맥판치환화(혹)관맥방로이식술,순행주동맥궁부강내복막지가치입술.비교체외순배조여동기채용전통심저온정순배수술행주동맥궁치환자적체외순배、주동맥조단、ICU시간급혈제품비용.결과 전조균성공동기완성수술병치입복막지가.상온조지가직경(40.80±1.79)mm,지가장도(189.0±14.39)mm.1례병인술후제6천돌연사망,시검증실위원단협층파렬.체외순배조체외순배(132.0±24.00)min,주동맥조단(49.18±12.09)min;지가직경(33.82±0.60)mm,지가장도(187.91±6.33)mm;1례병인술후5천CT발현종격적액,개흉탐사증실위림파적액;1례병인술후12천사우호흡쇠갈급신공능쇠갈."잡교"체외순배조체외순배화주동맥조단시간명현소우전통수술수조(P＜0.05);"잡교"수술자ICU천수명현소우전통수술조(P＜0.05);"잡교"수술자사용혈제품량급비용야명현소우전통수술조(P＜0.05).전조수방12～20개월,평균(14.45±2.33)개월.수방자균생존차회복정상생활,무명현불괄.CT복사지가무이위급내루.술후조기지가단가강폐합솔100%.술후3개월원단협층무변화,부분병인원단협층혈전형성.결론 일기"잡교"주동맥궁체환수술안전、유효,능교전통수술명현축단수술시간,감소수술창상,축단주원천수,감소수혈,취득만의적조기치료효과;단중、원기료효상수진일보수방.
Objective To summarize the clinical experience of one stage hybrid operation for aortic arch replacement and explore the indication. Methods From July,2009 to March,2010, 22 consecutive patients received one stage hybrid operation in our hybrid suite for aortic dissection or aortic aneurysm involving aortic arch. Two operative methods are used. (1)Bypass from ascending aorta to brachiocephalic arteries using midstemotomy and normothermia with antegrade aortic arch endovascular stented graft implantation. (2) Ascending aorta replacement and/or aortic valve replacement and/or coronary artery bypass grafting using midstemotomy and cardiopulmonary bypass with antegrade aortic arch endovascular stented graft implantation. Results All patients were technically successful. Angiography during the operation showed 100% patency of all the bypass grafts and no obvious translocation or endoleak of the stents. One patient in the first group died on sixth day after operation due to distal dissection rupture. There was one case of mediastinal lymph effusion in the second group and one case of death due to renal failure and respiratory failure 12 days after operation in the second group. The ICU stay and hospital stay were obviously shorter in hybrid open chest group than that in traditional open chest operation group(P ＜0.05). The blood product consumption and expenditure were also obviously less in hybrid open chest group than that in traditional open chest operation group (P ＜0.05). All the patients were followed up with a mean period of (14.45 ±2.33) months (range: 12 -20 months). All other patients were recovered with normal social life. CT showed neither endoleak nor translocation of the stented grafts. Faulse lumen closure rate at stented-graft segment is 100%. There was no obvious change of distal part of the dissection three months after operation except some thrombosis formation in some of the false lumen. Conclusion One stage hybrid operation for aortic arch replacement is safe and effective in shortening the duration of the operation and reducing the surgical trauma and risk of interval between procedures, shortening the hospital stay and reducing the blood product consumption compared with conventional operation with satisfactory early results. The midterm and long term results are still needed to be followed up.