深低温停循环主动脉弓部手术  

Aortic arch operation under deep hypothermic circulatory arrest

作　　者：汪黎明[1] 陈鑫[1] 石开虎[1] 徐明[1] 蒋英硕[1] 肖立琼[1] 赵海鹏[1] 刘培生[1] 王睿[1] 郑林[1] 

机构地区：[1]南京医科大学附属南京第一医院胸心外科,210006

出　　处：《中华医学杂志》2009年第1期45-47,共3页National Medical Journal of China

摘　　要：目的总结深低温停循环主动脉弓部手术的外科治疗经验。方法对22例原发疾病主要为主动脉夹层动脉瘤和降主动脉瘤累及弓部患者实施深低温停循环主动脉弓部手术治疗，其中8例行升主动脉＋部分主动脉弓替换术，1例行主动脉根部替换术＋升主动脉＋部分主动脉弓替换术，2例行升主动脉替换＋全弓替换术，2例行主动脉瓣替换术＋升主动脉替换＋部分主动脉弓替换术，8例行升主动脉替换＋全弓替换术＋象鼻技术（支架象鼻6例），1例行主动脉左半弓＋降主动脉置换。4例同时行冠状动脉搭桥手术。结果围手术期死亡3例，病死率13．6％。死亡原因：1例手术前夹层已经破裂，心脏压塞，急性下壁心肌梗死，心脏停跳，复苏同时手术，手术后严重右心衰，手术后16h死亡；1例手术后出血＋多器官功能衰竭，手术后3d死亡；1例急性主动脉夹层患者未醒并发肺部感染＋多器官功能衰竭，手术后39d死亡。手术后并发症：出血2次开胸3例；延迟苏醒3例；肾功能衰竭2例。结论主动脉弓部病变需根据手术前不同的原发病和病变累及的范围制定合理的手术方案，包括半弓、全弓和全弓＋象鼻手术；深低温停循环结合选择性脑灌注是一种简便易行的脑保护方法，有利于降低主动脉弓部手术死亡率和并发症的发生率。Objective To summarize the surgical experience of aortic arch operation under deep hypothermic circulatory arrest. Methods 22 patients suffering from aortic dissection or descending aorta aneurysm with the involvement of aortic arch received operation under deep hypothermic circulatory arrest. Eight patients underwent ascending aorta and partial aortic arch replacement, one patient received aortic root, ascending aorta, and partial aortic arch replacement, 2 patients received ascending aorta and total arch replacement, 2 patients received aortic valve replacement plus ascending aorta and partial aortic arch replacement, 8 patients underwent ascending aorta and total arch replacement plus elephant trunk technique （ stinted elephant trunk used in 6 cases） , and 1 patient received left partial aortic arch and descending aorta replacement. Coronary artery bypass grafting was performed concomitantly in 4 cases. Results Three patients died peri-operatively with a mortality rate of 13.6%. One patient had aortic dissection rupture before operation leading to cardiac tamponade, acute inferior myocardial infarction, and cardiac arrest. This patient received operation while resuscitation. After operation, the patient had severe right heart failure and died 16 hours later. One patient had bleeding and multi-organ failure, and died 3 days later. The third patient, with acute aortic dissection did not awake after operation, had pulmonary infection and multi-organ failure, and died 39 days later. Re-thoracotomy for bleeding was required in 3 cases; delayed awakenness occurred in 3 cases; and 2 cases had renal failure after operation. Conclusions Aortic arch operation includes partial aortic arch replacement, total arch replacement, and total arch replacement with elephant trunk technique. The operation procedure is selected according to the primary lesion and how aortic arch has been affected. Deep hypothermic circulatory arrest with selective cerebral perfusion facilitates complicated aortic arch operation, resulting in a

关 键 词：主动脉疾病 主动脉 胸 低温 

分 类 号：R686[医药卫生—骨科学]