CAJ | 학술논문

目的总结胸主动脉瘤的外科治疗方案以及经验体会。方法回顾性分析2003年9月—2013年10月蚌埠医学院第一附属医院心胸外科收治的75例各类胸主动脉病变患者的临床资料。其中9例Stanford A型主动脉夹层动脉瘤患者,行升主动脉+主动脉全弓置换手术3例、升主动脉+主动脉半弓置换手术6例；26例Stanford B型主动脉夹层动脉瘤患者,行体外循环下人工血管置换8例、腔内隔绝术18例；22例风湿性主动脉瓣病变合并升主动脉瘤样扩张患者(升主动脉直径>5 cm),行升主动脉置换+主动脉瓣置换术13例、升主动脉包裹+主动脉瓣置换术9例；17例马凡综合征患者行Bentall手术；1例升主动脉瘤合并先天性主动脉弓缩窄(导管后型)、主动脉瓣反流患者,在完成Bentall手术后行升主动脉至双侧股动脉搭桥手术。结果75例患者均手术顺利,手术时间65~280 min,平均(166.5依76.7)min；主动脉阻断时间28~138 min,平均(78.5依33.4)min；选择性脑灌注时间24~106 min,平均(53.1依18.7) min。1例行升主动脉+主动脉全弓置换手术患者因术后出血、多器官衰竭死亡。2例Bentall手术者因术后出血较多予二次手术止血。术后肺部感染3例、肾功能衰竭2例、短暂性室性心动过速1例、顽固性电解质紊乱1例,予积极对症治疗,均痊愈。行腔内隔绝术患者术后未见血管内漏及支架移位等并发症。65例获随访,随访6~110个月,平均(50.2依10.8)个月。随访期间,1例出现肠梗阻患者经保守治疗痊愈,1例因脑梗塞死亡,其余患者恢复满意,生活质量与治疗前相比,均得到显著提高。结论胸主动脉瘤种类较多,在进行胸主动脉瘤的治疗时,根据患者的具体情况、选择个体化治疗方案是取得良好治疗效果的关键。
목적총결흉주동맥류적외과치료방안이급경험체회。방법회고성분석2003년9월—2013년10월방부의학원제일부속의원심흉외과수치적75례각류흉주동맥병변환자적림상자료。기중9례Stanford A형주동맥협층동맥류환자,행승주동맥+주동맥전궁치환수술3례、승주동맥+주동맥반궁치환수술6례；26례Stanford B형주동맥협층동맥류환자,행체외순배하인공혈관치환8례、강내격절술18례；22례풍습성주동맥판병변합병승주동맥류양확장환자(승주동맥직경>5 cm),행승주동맥치환+주동맥판치환술13례、승주동맥포과+주동맥판치환술9례；17례마범종합정환자행Bentall수술；1례승주동맥류합병선천성주동맥궁축착(도관후형)、주동맥판반류환자,재완성Bentall수술후행승주동맥지쌍측고동맥탑교수술。결과75례환자균수술순리,수술시간65~280 min,평균(166.5의76.7)min；주동맥조단시간28~138 min,평균(78.5의33.4)min；선택성뇌관주시간24~106 min,평균(53.1의18.7) min。1례행승주동맥+주동맥전궁치환수술환자인술후출혈、다기관쇠갈사망。2례Bentall수술자인술후출혈교다여이차수술지혈。술후폐부감염3례、신공능쇠갈2례、단잠성실성심동과속1례、완고성전해질문란1례,여적겁대증치료,균전유。행강내격절술환자술후미견혈관내루급지가이위등병발증。65례획수방,수방6~110개월,평균(50.2의10.8)개월。수방기간,1례출현장경조환자경보수치료전유,1례인뇌경새사망,기여환자회복만의,생활질량여치료전상비,균득도현저제고。결론흉주동맥류충류교다,재진행흉주동맥류적치료시,근거환자적구체정황、선택개체화치료방안시취득량호치료효과적관건。
Objective To summarize the method and experience for the treatment of thoracic aortic aneurysms. Methods Clinical data of 75 patients with thoracic aortic aneurysms in the First Affiliated Hospital of Bengbu Medical College from September 2003 to October 2013 were retrospectively analyzed. Among them, 9 patients with acute Stanford type A aortic dissection, 3 patients with ascending aorta replacement and total aortic arch replacement, 6 patients of ascending aorta replacement and hemi-aortic arch replacement. In 26 patients for Stanford type B, there were 8 patients with artificial vascular replacement and 18 patients with endovascular graft exclusion. In 22 patients with rheumatic aortic lesions combined with expansion of the ascending aorta(ascending aorta diameter>5 cm), there were 13 patients with aortic dissection ascending aorta replacement and aortic valve replacement and 9 patients with the ascending aorta package and aortic valve replacement. Bentall surgery was performed for in 17 patients with marfan’s syndrome. Bentall surgery combined with bypass suregery from ascending aorta to bilateral femoral artery was conducted for 1 patient. Results The operation smoothly in all the patients, the operation time was 65 - 280 min, the average operative time was ( 166. 5 ± 76. 7 ) min. The blocking time was 28-134 min. The average was ( 78. 5 ± 33. 4 ) min. The selective cerebral perfusion time was 24-106 min. The average was (53. 1±18. 7)min. One patient died of postoperative bleeding and multiple organ failure. Two patients underwent the second operation for bleeding, postoperative pulmonary infection occurred in 3 patients, kidney failure in 2 patients, transient ventricalar tachycardia in one patient and refractory electrolyte disorder in one patient. Patients were well out of the hospital after treatment. There were no patients with endoleak and migration during treatment with endovascular graft exclusion. We followed-up 65 patients. The follow-up time was 6-110 months. The average was (50. 2±10. 8) months. During the following-up, one patient with inxestinal obstruction was cured, one patient died of cerebral in-farction. the others got satisfactory recovery and had a high qualily of life compared with the preoperation. Conclusions According to disease situation of patients, to select individualized treatment is the key to achieve good effect for thoracic aortic aneurysms patients.