升主动脉根部和主动脉弓替换的外科治疗  

Surgical treatment of the Ascending Aortic root and Aortic arch replacement

作　　者：曹德生[1] 王凤林[1] 刘鹏[1] 周明[1] 王非[1] 林凡[1] 

机构地区：[1]中日友好医院心血管外科

出　　处：《中国心血管病研究》2005年第8期577-579,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的总结并讨论我科15例升主动脉和主动脉弓替换手术的临床体会。方法在中低温体外循环下,应用带瓣人工管道行升主动脉根部替换手术10例。用人工血管和人工瓣自行缝制带瓣管道3例,预制带瓣人工管道6例。1例行主动脉瓣替换加升主动脉补片术,1例行腔内人工血管移植术。冠状动脉移植应用纽扣法6例,直接移植3例,Cabrol法1例。在深低温停循环脑顺行灌注下行人造主动脉弓(用Medox24mm和8mm人工血管自行缝制)替换3例。其中1例DeBakeyⅢ型术后6年的患者复发,DeBakeyI同时行升主动脉根部替换。结果行主动脉根部替换平均主动脉阻断时间130min。行主动脉弓替换主动脉阻断时间为112～240min(平均170min),停循环30～65min(平均46min),脑选择顺行灌注63～92min(平均80min)。无脑及脊髓并发症。声音嘶哑1例。术后早期死亡1例。随访2～8年,病情稳定,术后心脏功能NYHAⅠ级11例,Ⅱ级3例。结论升主动脉根部手术,特别是联合主动脉弓替换,手术复杂,风险大。为确保手术成功,各吻合口要精确吻合,无张力,无扭转,对头臂干的吻合宜采取分支吻合的方法。应用深低温停循环联合选择性脑顺行灌注进行脑保护。Objective To summarize the surgical experience of the ascending aortic root and aortic arch replacement with 15 cases report. Methods To performed ascending aortic root replacement with conduits by using moderate hypothermic CPB in 10 cases.CABG with Button technique for coronary artery anastomosis for 6 cases,Cabrol way for 1 cases,the other 3 cases were anastomested directly.Aortic arch replacement by deep hypothermic circulatory arrest （DHCA） with antegrade cerebral perfusion for 3 cases.Including 1 cases with DeBakey Ⅰ dissection re-occurred 6 years later after operation for his DeBakey Ⅲ dissection were simutaueously replaced with aortic root. Results Cardiopulmonary bypass average time was 130 min in the aortic root replacement.Cardiopulmonary bypass average time was 170 min（ 112-240 min）.Average selective cerebral perfusion was 80min（63-92 min）.Without cerebral and spinal cord complication. Hoarseness occurred in Ⅰ cases.1 patient died early after operation.There was no death during follow-up.NYHA heart function were class Ⅰ and Ⅱ （11 cases and 3 cases）.Conclusion Aortic root replacement,especially combining with aortic arch replacement,is very complicated with high risk, Inorder to achieve good surgical result, skillful operative technique ,proper choice of branches anestomsis for arch is key point, and DHCA with antegrade cerebral perfusion is necessary.

关 键 词：主动脉 主动脉弓替换 体外循环 

分 类 号：R654.3[医药卫生—外科学]