非体外循环下成人复杂型主动脉缩窄的解剖矫治  

Off-pump Anatomic Surgical Repair for Complex Coarctation in Adults

作　　者：孙宏涛[1] 于存涛[1] 常谦[1] 冯钧[1] 贺东[1] 钱向阳[1] 徐晋[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心血管病研究所心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2011年第3期214-217,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的为提高成人复杂型主动脉缩窄的矫治效果,探讨其最佳外科治疗策略。方法回顾性分析北京阜外心血管病医院2005年1月至2008年12月在非体外循环下一期解剖矫治7例成人复杂型主动脉缩窄患者的临床资料,其中男5例,女2例;年龄16~41岁,平均年龄24.4岁。合并主动脉弓发育不良2例,主动脉弓部动脉瘤1例,胸降主动脉瘤3例（其中合并B型主动脉夹层1例）,主动脉缩窄手术后再狭窄1例。全组患者术前均通过彩色超声心动图、CT或磁共振成像确诊。均在全身麻醉常温非体外循环下手术,手术入路为胸骨正中切口1例,左后外侧切口6例;解剖矫治为：主动脉弓补片加宽4例,降主动脉人工血管置换3例（其中1例同期行腹主动脉置换,1例B型主动脉夹层同期植入支架象鼻）。结果全组无手术死亡,无严重手术并发症。随访7例,随访时间6~49个月,平均随访20.1个月,无远期死亡,无主动脉缩窄复发二次手术患者。有1例术后出现声音嘶哑,随访11个月时声音嘶哑未改善。结论非体外循环下对成人复杂型主动脉缩窄行一期解剖矫治是安全可行的,近、远期效果良好。Objective To investigate the clinical results of off-pump anatomic surgical repair for complex coarctation in adults.Methods We retrospectively analyzed the clinical data of 7 patients with complex coarctation who underwent one-stage anatomic surgical repair between January 2005 and December 2008 in Fu Wai Hospital.There were 5 males and 2 females with the age ranged from 16 to 41 years,average at 24.4 years.Among all the patients,there were 2 patients of coarctation with hypoplastic aortic arch,1 of coarctation with aortic arch aneurysm,3 of coarctation with descending thoracic aortic aneurysm,and 1 of coarctation with B type aortic dissection.All patients were diagnosed by color echocardiography,CT or magnetic resonance imaging（MRI）.All off-pump operations were performed under general anesthesia and ambient temperature.Median sternotomy was performed in 1 patient and left thoracotomy in 6 patients.Aortic arch patching enlargement was performed in 4 patients and descending thoracic aorta replacement in 3 patients（including 1 combined with abdominal aorta replacement and 1 case of Stanford B type aortic dissection,trunk stent was transplanted at the same time）.Results There was no hospital mortality or severe surgical complications.Seven patients were followed up for a period ranged from 6 to 49 months with an average time of 20.1 months.No late death or recoarctation occurred.Hoarseness occurred in one patient and presented no improvement during the 11 months follow-up.Conclusion One-stage off-pump anatomic surgical repair is safe and feasible in treating adult patients with complex coarctation,and it shows a good immediate and long-term result.

关 键 词：复杂型主动脉缩窄 成人 外科修补 

分 类 号：R654.3[医药卫生—外科学]