CAJ | 학술논문

目的评价采用常温、非体外循环下全主动脉弓替换手术治疗主动脉弓、降部动脉瘤的术后早、中期结果.方法 2004年4月至11月,对连续7例主动脉弓降部动脉瘤病人实施常温、非体外循环下全主动脉弓替换手术.术后对所有病人进行长期随访,随访截止日期为2011年3月.7例均为男性,年龄23～75岁,中位年龄57岁.真性动脉瘤3例,假性动脉瘤4例,其中1例为弓降部巨大假性动脉瘤覆膜支架置入术失败者.采用胸部正中与左胸前外侧联合切口,全身肝素化后,依次在升主动脉前外侧壁安放主动脉侧壁钳,降主动脉与头臂动脉分别放置主动脉阻断钳,将带四分支人工血管依次与升主动脉行端-侧吻合、与降主动脉及3支头臂动脉行端-端吻合,最后闭合升主动脉残端,切除弓降部主动脉瘤壁.结果平均胸降主动脉阻断(13.6±5.6)min,左颈总动脉阻断(5.7±0.8)min,无名动脉阻断(7.8±2.5)min,左锁骨下动脉阻断(11.2±1.5)min.术后使用呼吸机平均(12.3±4.1)h.病人全部生存.与同期常温体外循环下主动脉弓替换手术组相比,本组机械通气时间显著减少.无神经系统并发症.术后CT扫描结果显示,主动脉弓降部人工血管形态佳,吻合口周围无渗漏或假性动脉瘤形成.全组平均随访(79.7±2.1)个月,病人生活质量良好,复查CT结果均未见异常.无远期死亡.结论在常温、非体外循环状态下实施全主动脉弓替换手术,是一种治疗主动脉弓、降部真性或假性动脉瘤的安全、有效的方法,严格把握手术适应证是手术成功的关键.
목적 평개채용상온、비체외순배하전주동맥궁체환수술치료주동맥궁、강부동맥류적술후조、중기결과.방법 2004년4월지11월,대련속7례주동맥궁강부동맥류병인실시상온、비체외순배하전주동맥궁체환수술.술후대소유병인진행장기수방,수방절지일기위2011년3월.7례균위남성,년령23～75세,중위년령57세.진성동맥류3례,가성동맥류4례,기중1례위궁강부거대가성동맥류복막지가치입술실패자.채용흉부정중여좌흉전외측연합절구,전신간소화후,의차재승주동맥전외측벽안방주동맥측벽겸,강주동맥여두비동맥분별방치주동맥조단겸,장대사분지인공혈관의차여승주동맥행단-측문합、여강주동맥급3지두비동맥행단-단문합,최후폐합승주동맥잔단,절제궁강부주동맥류벽.결과 평균흉강주동맥조단(13.6±5.6)min,좌경총동맥조단(5.7±0.8)min,무명동맥조단(7.8±2.5)min,좌쇄골하동맥조단(11.2±1.5)min.술후사용호흡궤평균(12.3±4.1)h.병인전부생존.여동기상온체외순배하주동맥궁체환수술조상비,본조궤계통기시간현저감소.무신경계통병발증.술후CT소묘결과현시,주동맥궁강부인공혈관형태가,문합구주위무삼루혹가성동맥류형성.전조평균수방(79.7±2.1)개월,병인생활질량량호,복사CT결과균미견이상.무원기사망.결론 재상온、비체외순배상태하실시전주동맥궁체환수술,시일충치료주동맥궁、강부진성혹가성동맥류적안전、유효적방법,엄격파악수술괄응증시수술성공적관건.
Objective Study the early and midterm results of a technique-total aortic arch replacement without using extracorporeal circulation or aortic bypass for the treatment of aortic aneurismal disease involving the transverse aortic arch and proximal descending aorta. Methods Between April and November 2004, 7 consecutive patients with true (n = 3) or false (n =4) aortic aneurysm underwent this procedure. The mean follow-up was 6. 6 years. The median age at operation was 57years ( range 23 to 75 years). Normothermia general anesthesia and median sternotomy combined with left anterior thoracotomy were administered. A partially occluding clamp was placed on ascending aorta and a longitude aortic incision was made. Anastomosis of a branched graft to ascending aorta in an end-to-side fashion was commenced. The descending aorta distal to the aneurysm was occluded and transected, and anastomosed to the distal end of the branched graft in an end-to-end fashion. Finally,the arch vessels were divided and anastomosed to the branches of the graft and the aneurysm excised. Results The average cross-clamp time of descending aorta, left common carotid artery, and innominate artery was (13.6 ±5.6)min, (5.7 ±0.8)min, and (7.8±2.5) min respectively. The mean intubation time was (12.3 ±4.1) hours. There were no adverse outcomes or neurologic complications in this series. All patients survived and recovered completely. The mean follow-up time was (79.7 ±2.1) months. All patients lead a normal life. There was no late death. CT follow-up study 6 years after surgery reveals no abnormal image. Conclusion Total aortic arch replacement without cardiopulmonary and aortic bypass is a feasible and effective method for the aortic aneurismal disease involving the transverse aortic arch and proximal descending aorta in selected patients.