CAJ | 학술논문

目的：探讨孙氏手术基础上加用升主动脉-股动脉旁路移植术治疗复杂型 Stanford A型主动脉夹层手术时机的选择。方法31例复杂型 Stanford A 型主动脉夹层患者,年龄(49±15)岁,体质量(73±15)kg,均行孙氏手术,术前监测患者肾功能,应用320排容积 CT 进行胸腹主动脉 CTA扫描,计算降主动脉真腔最小面积和同一平面降主动脉面积,复温阶段监测患者上、下肢血压及1 h内尿量。对于真腔最小面积小、降主动脉远端无破口、术中尿量少、上下肢压差大于>60 mmHg 的12例患者进一步进行升-股旁路移植术。结果影响选择升-股旁路移植术的相关手术时机因素有：(1)肾动脉平面及以上降主动脉真腔最小面积占同一平面降主动脉面积的百分比<1.5%；(2)上肢收缩压与下肢收缩压压差>20 mmHg；(3)手术复温阶段尿量偏少,或者利尿效果不佳；(4)降主动脉远端无破口。结论对复杂型 A 型主动脉夹层患者的真腔最小面积、上下肢收缩压压差、复温阶段尿量及降主动脉远端破口进行监测,可决定是否加做升-股旁路移植术,对患者的预后有着积极的意义。
목적：탐토손씨수술기출상가용승주동맥-고동맥방로이식술치료복잡형 Stanford A형주동맥협층수술시궤적선택。방법31례복잡형 Stanford A 형주동맥협층환자,년령(49±15)세,체질량(73±15)kg,균행손씨수술,술전감측환자신공능,응용320배용적 CT 진행흉복주동맥 CTA소묘,계산강주동맥진강최소면적화동일평면강주동맥면적,복온계단감측환자상、하지혈압급1 h내뇨량。대우진강최소면적소、강주동맥원단무파구、술중뇨량소、상하지압차대우>60 mmHg 적12례환자진일보진행승-고방로이식술。결과영향선택승-고방로이식술적상관수술시궤인소유：(1)신동맥평면급이상강주동맥진강최소면적점동일평면강주동맥면적적백분비<1.5%；(2)상지수축압여하지수축압압차>20 mmHg；(3)수술복온계단뇨량편소,혹자이뇨효과불가；(4)강주동맥원단무파구。결론대복잡형 A 형주동맥협층환자적진강최소면적、상하지수축압압차、복온계단뇨량급강주동맥원단파구진행감측,가결정시부가주승-고방로이식술,대환자적예후유착적겁적의의。
Objective To study the opportunity of femoral artery bypass grafting surgery on the basis of Sun's Procedure for complex Stanford type A aortic dissection. Methods Thirty-one patients with complex Stanford type A aortic dissection, with mean age (49 ± 15) years old and weight (73 ± 15) kg were enrolled in this study. Patients' renal function before the surgery was measured and chest and abdomen aorta were scanned by Toshiba Aquilion ONE 320 CT machine. The smallest true lumen area and descending aorta area at the same plane were calculated. Systolic blood pressure of upper and lower extremities and urine volume within 1 hour were monitored. Results The opportunity of femoral artery bypass grafting surgery was influenced by the following factors: (1) the proportion of the minimum true lumen area in the descending aorta area < 1. 5% ;(2) systolic blood pressure difference between upper and lower limb > 20 mmHg;(3) decreased urine volume or poor response to diuretics; (4) without breaking at distal descending aorta. Conclusions The minimum area of true lumen, upper and lower limbs systolic blood pressure difference, urine volume and descending aorta distal crevasse monitoring can be used to evaluate the operation opportunity of the femoral artery bypass grafting in patients with Stanford A complex aortic dissection.