临床外科杂志
臨床外科雜誌
림상외과잡지
JOURNAL OF CLINICAL SURGERY
2014年
10期
762-766
,共5页
邓宏平%王志维%夏军%胡小平%江万里
鄧宏平%王誌維%夏軍%鬍小平%江萬裏
산굉평%왕지유%하군%호소평%강만리
主动脉夹层%深低温停循环%脑保护%支架象鼻
主動脈夾層%深低溫停循環%腦保護%支架象鼻
주동맥협층%심저온정순배%뇌보호%지가상비
aortic dissection%deep hypothermia circulatory arrest%cerebral protection%stented elephant trunk
目的:评价急性复杂型Stanford A 型主动脉夹层手术中改良双侧选择性顺行脑保护的效果及升主动脉插管、左锁骨下动脉(LSA)“开窗”技术对手术风险的影响。方法122例急性复杂型Stanford A 型主动脉夹层患者行改良全主动脉弓置换加降主动脉内支架象鼻植入术,按照脑保护及动脉供血管插管方式分为单侧脑保护组与改良双侧脑保护组及右锁骨下动脉(RSA)插管组与主动脉插管组,比较各组的手术方式、死亡率及并发症率。部分患者采用左锁骨下动脉“开窗”技术重建血运。结果单侧脑保护组与改良双侧脑保护组总的院内死亡率分别为5.77%、2.86%,差异无统计学意义(P值为0.650);神经系统总并发症率分别为26.92%、10.00%,差异有统计学意义(P值为0.014)。右锁骨下动脉插管组与升主动脉插管组总的院内死亡率均为4.55%,总并发症率分别为15.9%、15.2%,差异均无统计学意义(P值分别为1、0.914)。左锁骨下动脉“开窗”者术后多次复查CTA左锁骨下动脉均通畅,无左锁骨下盗血综合征发生,1例出现无需处理的少量内漏。结论改良双侧选择性顺行脑保护安全、可行、可靠;选择升主动脉插管符合生理、操作简捷,不增加手术风险;左锁骨下动脉“开窗术”简化了手术,缩短了深低温停循环时间,增加了手术安全性。
目的:評價急性複雜型Stanford A 型主動脈夾層手術中改良雙側選擇性順行腦保護的效果及升主動脈插管、左鎖骨下動脈(LSA)“開窗”技術對手術風險的影響。方法122例急性複雜型Stanford A 型主動脈夾層患者行改良全主動脈弓置換加降主動脈內支架象鼻植入術,按照腦保護及動脈供血管插管方式分為單側腦保護組與改良雙側腦保護組及右鎖骨下動脈(RSA)插管組與主動脈插管組,比較各組的手術方式、死亡率及併髮癥率。部分患者採用左鎖骨下動脈“開窗”技術重建血運。結果單側腦保護組與改良雙側腦保護組總的院內死亡率分彆為5.77%、2.86%,差異無統計學意義(P值為0.650);神經繫統總併髮癥率分彆為26.92%、10.00%,差異有統計學意義(P值為0.014)。右鎖骨下動脈插管組與升主動脈插管組總的院內死亡率均為4.55%,總併髮癥率分彆為15.9%、15.2%,差異均無統計學意義(P值分彆為1、0.914)。左鎖骨下動脈“開窗”者術後多次複查CTA左鎖骨下動脈均通暢,無左鎖骨下盜血綜閤徵髮生,1例齣現無需處理的少量內漏。結論改良雙側選擇性順行腦保護安全、可行、可靠;選擇升主動脈插管符閤生理、操作簡捷,不增加手術風險;左鎖骨下動脈“開窗術”簡化瞭手術,縮短瞭深低溫停循環時間,增加瞭手術安全性。
목적:평개급성복잡형Stanford A 형주동맥협층수술중개량쌍측선택성순행뇌보호적효과급승주동맥삽관、좌쇄골하동맥(LSA)“개창”기술대수술풍험적영향。방법122례급성복잡형Stanford A 형주동맥협층환자행개량전주동맥궁치환가강주동맥내지가상비식입술,안조뇌보호급동맥공혈관삽관방식분위단측뇌보호조여개량쌍측뇌보호조급우쇄골하동맥(RSA)삽관조여주동맥삽관조,비교각조적수술방식、사망솔급병발증솔。부분환자채용좌쇄골하동맥“개창”기술중건혈운。결과단측뇌보호조여개량쌍측뇌보호조총적원내사망솔분별위5.77%、2.86%,차이무통계학의의(P치위0.650);신경계통총병발증솔분별위26.92%、10.00%,차이유통계학의의(P치위0.014)。우쇄골하동맥삽관조여승주동맥삽관조총적원내사망솔균위4.55%,총병발증솔분별위15.9%、15.2%,차이균무통계학의의(P치분별위1、0.914)。좌쇄골하동맥“개창”자술후다차복사CTA좌쇄골하동맥균통창,무좌쇄골하도혈종합정발생,1례출현무수처리적소량내루。결론개량쌍측선택성순행뇌보호안전、가행、가고;선택승주동맥삽관부합생리、조작간첩,불증가수술풍험;좌쇄골하동맥“개창술”간화료수술,축단료심저온정순배시간,증가료수술안전성。
Objective To evaluate the effects of modified bilateral antegrade selective cerebralperfusion and surgical risks of ascending aorta cannulation and fenestration of the left subclavian artery(LSA)for complicated acute Standford type A aortic dissection.Methods A total of 122 consecutive patients with complicated acute Standford type A aortic dissection received modified aortic arch replacementand stented elephant trunk implantation in the ascending aorta.According to the methods of intubation andcerebral protection,patients were divided into the unilateral and bilateral cerebral protection groups andright subclavian artery(RSA)and aorta intubation groups,respectively.Surgical procedures,mortality rateand complication rate were compared between groups.Fenestration of the LSA was used to reconstruct thecirculation in some patients.Results The inhospital mortality rates of unilateral and bilateral cerebralprotection groups were 5.77% and 2.86%(P =0.650)and their neurological complication rates were26.92% and 10.00%(P =0.014),respectively.The inhospital mortality rates of RSA and ascending aorta cannulation groups were both 4.55%(P =1),and the complication rates were 15.9% and 15.2%(P =0.914),respectively.Multiple reexaminations of CTA were carried out in patients receiving fenestration of the LSA,and no signs of subclavian steal syndrome were revealed.Only one patient had minor leakage and it did not need futher management.Conclusion Modified bilateral antegrade selective cerebralperfusion is a safe,feasible and reliable method.Ascending aorta cannulation is both physiological and simple without increasing surgical risks.Fenestration of the LSA can simplify procedures,shorten deep hypothermic circulatory arrest and increase surgical safety.