应用四分支血管分段停循环下全胸腹主动脉替换术  

One-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest

作　　者：于存涛[1] 孙立忠[1] 常谦[1] 朱俊明[1] 刘永民[1] 

机构地区：[1]中国医学科学院北京阜外心血管病医院血管外科中心,100037

出　　处：《中华医学杂志》2006年第3期167-169,共3页National Medical Journal of China

摘　　要：目的 总结应用四分支血管在深低温、分段停循环下行全胸腹主动脉替换术的经验。方法 自2003年8月至2005年5月，连续行全胸腹主动脉替换术38例（男25例，女13例），年龄22～58（40±9）岁，体重49～105（67±19）kg。其中胸腹主动脉真性动脉瘤4例（Crawford Ⅱ型），慢性StanfordB型夹层瘤24例，慢性StanfordA型主动脉夹层瘤5例（均为二次手术），马方综合征合并慢性StanfordB型夹层瘤5例（2例为二次手术）。采用深低温、分段停循环技术。经左后外侧沿腹直肌旁至耻骨联合胸腹联合切口、第五肋间进胸、断肋弓、腹膜外入路，应用四分支人造血管行全胸腹主动脉替换。结果 术后早期死亡2例（病死率5．26％）。神经系统并发症4例（昏迷超过3d），经脱水及神经营养治疗后痊愈。急性肾衰2例，经血滤治疗痊愈。结论 选用四分支人造血管，采用分段停循环技术行全胸腹主动脉瘤切除、人工血管替换术，能简化手术方式，明显缩短脑、脊髓和重要脏器的缺血时间，效果良好。Objective To summarize the experience in one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest. Methods From August 2003 to May 2005 38 patients with thoracoabdominal aortic disease, including severe extensive thoracoabdominal aorta of Crawford Ⅱ type （ n = 4 ）, chronic Stanford type B dissecting aneurysm （ n = 24 ）, chronic Stanford type A dissecting aneurysm （ n = 5 ）, and Marfan＇s syndrome with chronic Stanford type B dissecting aneurysm （n=5） , 25 males and 13 females, aged 40 ± 9 （ 22 - 58 ） , underwent one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest. Results Two patients died during the early post-operational period with a mortality of 5.26%. Four patients showed cerebral complications with an incidence of 10.5% and were cured after hydration therapy. Acute kidney dysfunction occurred in 2 patients and was cured by hemodialysis. Conclusion With simplified operational procedure, one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest significantly shortens the ischemic time of brain, spinal cord, and other major organs and has an excellent effect.

关 键 词：主动脉瘤 人工血管 体外循环 主动脉替换 

分 类 号：R654.3[医药卫生—外科学] R732.210.6[医药卫生—临床医学]