主动脉缩窄的手术方式选择与围术期注意事项  

Selection of surgical approach for aortic coarctation and precautions during perioperative period

作　　者：张卫[1] 叶伟[1] 邱兆昆[1] 方亮[1] 

机构地区：[1]上海交通大学附属胸科医院心血管外科,200030

出　　处：《上海医学》2008年第4期254-255,共2页Shanghai Medical Journal

摘　　要：目的探讨主动脉缩窄的手术方式选择与围术期注意事项。方法85例主动脉缩窄患者中,行缩窄切除、端-端吻合5例,缩窄处纵切横缝3例,缩窄段切除、行人造血管移植49例,缩窄段纵行切开、行人造血管片扩大成形术16例,左锁骨下动脉远端切断作为旁路连接到缩窄远端5例,左锁骨下动脉远端切断、从内侧纵行切开行补片扩大成形术2例,缩窄近、远端人造血管旁路5例。结果无死亡、截瘫病例。术后出血3例,均经剖胸止血治愈。早期发生声音嘶哑22例,高血压55例(需药物控制)。所有患者均存活,无术后动脉瘤形成、主动脉再狭窄和残存高血压,上、下肢收缩压差值为0～20 mmHg(1 mmHg=0.133 kPa),生活质量佳。结论外科手术治疗主动脉缩窄仍是目前首选方案,应视病变长短、合并症而采取不同的手术方法,并通过各种手段尽量避免复发及动脉瘤等并发症的发生。Objective To discuss the selection of surgical approach for aortic coarctation and the precaution during the perioperative period. Methods Eighty-five patients with aortic stenoses underwent 7 operative techniques, including resection with end to-end anastomosis （n=5）, resection with vertical incision and cross joint （n=3）, resection with artificial graft replacement （n=49）, aortoplasty with patch graft （n=16）, left subclavian artery desending aortic anastomosis （n= 5）, end-to-end anastomosis with reverse subclavian flap aortoplasty （n= 2） and aortic artificial graft bypass replacement （n = 5）. Results No surgical death or paraplegia occurred in our group. Postoperative hemorrhage occurred in 3 cases and all patients were cured by thoraeotomy hemostasls. Early stage hoarseness happened in 22 cases （spontaneous cure in 6 months）, hypertension was noticed in 55 cases （relieved by medicine）. There was no death, restenosis, aneurysm formation or persistent hypertension was noticed during follow up. The artery pressure gradient between upper and lower extremities was less than 20 mmHg and the patient led a life of high quality. Conclusion Surgical therapy is still the first choice for treatment of coarctation. The surgical methods should be selected according to the disease course, presence of complications, and measures should be taken to avoid complication such as recurrence and formation of aneurysm.

关 键 词：主动脉缩窄 外科治疗 围术期 

分 类 号：R654.3[医药卫生—外科学]