胸腹主动脉置换术治疗支架“象鼻”手术后胸腹主动脉夹层动脉瘤  

Surgery for thoracoabdominal aorta dissecting aneurysm following Sun＇s procedure with the aorta replacement

作　　者：刘巍[1] 孙立忠[1] 朱俊明[1] 刘永民[1] 陈雷[1] 里程楠[1] 乔志钰[1] 胡海瓯[1] 杨祎[1] 郭世超[1] 邢晓燕[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2012年第4期212-214,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨孙氏手术后远端胸腹主动脉夹层动脉瘤的手术方式和治疗经验。方法2009年6月至2011年5月，13例孙氏手术后胸腹主动脉夹层动脉瘤患者接受胸腹主动脉置换手术治疗。男11例，女2例；年龄28～58岁，平均39．3岁。均为StanfordA型主动脉夹层、孙氏手术后患者。病因为马方综合征10例，高血压3例。全组均为CrawfordⅡ型胸腹主动脉夹层动脉瘤。“象鼻”支架以远胸腹主动脉最大直径4．0—8．0cm，平均（5．78±1．00）em。经胸腹联合切口、腹膜外人路，采用四分支人工血管翻转、分段阻断技术行胸腹主动脉置换术。采用深低温停循环技术7例，常温非体外循环技术6例。结果无手术早期死亡。12例患者治愈出院。采用深低温停循环技术的患者中l例术后截瘫，后出现败血症、伪膜性肠炎、呼吸衰竭，于术后102天死亡。1例出现缺血、缺氧脑病，脱水治疗6天后清醒、治愈出院。全组患者术后胸腹主动脉螺旋CT复查示人工血管通畅、无扭曲、无假性动脉瘤。3例患者肋间动脉分支闭塞，但无脊髓缺血症状。患者均随访1—24个月，平均（9．6±2．1）个月。随访期间患者人工血管通畅，无假性动脉瘤形成，无脑部、脊髓及腹腔脏器等缺血表现。结论孙氏手术能降低手术难度；减少并发症。常温非体外循环下，采用四分支人工血管翻转、分段阻断技术可以简化胸腹主动脉置换术，减少并发症。Objective To explore the surgical techniques and clinical experiences in treating thoracoabdominal aorta dissecting aneurysm following Sun＇s procedure. Methods From June 2009 to May 2011, thoracoabdominal aorta replacement was performed in thirteen patients with thoracoabdominal aorta dissecting aneurysm following Sun＇s procedure in Beijing Anzhen Hospital. Among which, eleven were male, and two were female with a mean age 39.3 years （28 -58 years）. All cases were Stanford A aortic dissection, and were underwent Sun＇s Procedure. The pathogeny of the dissection, ten were Marfan＇s syndrome, and three were hypertension. Thoracoabdominal aorta dissecting aneurysms were all Crawford type IX , with the diameter （5.78 - 1.00）cm （4.0 -8.0cm）. All the procedures were performed through combined thoraeoabdominal incision via the retroperitoneal approach. And thoraeoabdominal aorta was replaced by a tetrafureate graft with short-time interval circulatory arrest. 24 - 30 mm tetrafurcate grafts were selected in all patients. The main graft of the tetrafureate graft was anastomosed to the ＂ elephant truck＂ stent graft. Visceral arteries were joined into a patch and were anastomosed to the other end of the main graft. T6 to T12 intercostal arteries were reconstructed by an 8 mm sidearm. Another 8 mm sidearm was anastomosed to the left renal artery. Both 10 mm sidearms were anastomosed to iliac arteries. Among which, seven were underwent by profound hypothermia with circulatory arrest, and six were underwent off pump with normal temperature. Results No early death. Twelve patients were cured and discharged from hospital. Seven patients were underwent profound hypothermia with circulatory arrest. Among which, one patient had paraplegia, sepsis, pseudomembranous colitis, respiratory failure, and died on 102-day after operation. Another one patient had neurological dysfunction and was cured after six-day＇s dehydrated treatment. The UFCT showed that the tetrafurcate graft was unobstructed, no distortion, no

关 键 词：主动脉 动脉瘤 夹层 心脏外科手术 胸主动脉 胸腹主动脉置换术 

分 类 号：R654.3[医药卫生—外科学]