保留自体头臂动脉的孙氏手术临床应用  

Experiences of Sun＇ s procedure with preservation of autologous brachiocephalic vessels

作　　者：朱俊明[1] 齐瑞东[1] 陈雷[1] 刘巍[1] 里程楠[1] 程力剑[1] 乔志钰[1] 葛翼鹏[1] 胡海鸥[1] 邢晓燕[1] 孙立忠[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科北京市主动脉疾病诊疗中心,100029

出　　处：《中华胸心血管外科杂志》2016年第3期143-146,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：2014卫生行业科研专项（201402009）,国家科技支撑计划（2015BA112803）

摘　　要：目的回顾性总结保留自体头臂动脉的孙氏手术的临床应用经验，探讨相关的手术技术和手术指征。方法2011年3月至2012年3月，17例主动脉夹层患者接受保留自体头臂动脉的孙氏手术，男14例，女3例；年龄24～62岁，平均（41±11）岁。术前合并下肢缺血3例，糖尿病2例，覆膜支架血管腔内置入术（TEVAR）术后夹层逆剥2例。冠心病、肾功能不全、二尖瓣反流和肺部感染行气管切开各1例。结果本组无手术死亡。体外循环（179±49）min，主动脉阻断（93±33）min，选择性脑灌注（28±4）min。同期Bentall手术5例，Bentall加二尖瓣置换手术1例，主动脉瓣成形术1例，冠状动脉旁路移植术加二尖瓣成形术1例，升主动脉一腋动脉转流术1例。2例术后呼吸机辅助超过24h，1例术后痰多肺功能差行二次气管插管，后因肾功能衰竭行持续性血液滤过，经治疗痊愈出院。结论应用保留自体头臂动脉的孙氏手术获得了满意的临床效果，但临床中应严格地掌握手术指征。Objective Retrospective study of surgical indication, technique and outcomes for treating aortic dissection involving repair of the aortic arch using Sun＇ s procedure with preservation of autologous brachiocephalic vessels. Methods From March 2011 to March 2012, 17 patients with aortic dissection [14 males, 3 females ; mean age （41 ± 11 ） years （ range, 24 -62 years） ] underwent total arch replacement using Sun＇ s procedure with preservation of autologous brachiocephalic ves- sels under hypothermic cardiopulmonary bypass（CPB） with antegrade selective cerebral perfusion. Preoperative complications included lower limb ischemia in 3 patients, diabetes mellitus in 2 patients, retrograde type h dissection after TEVAR in 2 pa- tients, coronary artery disease in 1 patient, renal dysfunction in 1 patient and mitral regurgitation in 1 patient. Tracheotomy was performed in 1 patient due to pulmonary infection. Results CPB time was （ 179 ± 49 ） min, aortic cross-clamp time was （93 ± 33 ） min and selective cerebral perfusion time was（ 28 ±4 ） min, respectively. Concomitant procedures included Bentall proce- dure in 5 patients, Bentall procedure and mitral valve replacement in 1, aortic valve plasty in 1, coronary artery graft bypass ＋ mitral valve plasty in 1 and ascending aorta-axillary artery bypass in 1. There was no in-hospital death. Ventilator support ex- ceeding 24 hours obseved in 2 patients. One of them recieved continuous renal replacement therapy and recovered before dis- charge. Conclusion Sun＇ s procedure with preservation of autologous brachiocephalic vessels obtained satisfactory surgical re- suits in suitable patients with aortic dissection. However, strict indication was necessary.

关 键 词：主动脉夹层 孙氏手术 全弓替换 

分 类 号：R654.3[医药卫生—外科学]