主动脉-髂动脉旁路全胸腹主动脉替换术对脊髓功能的影响  

Effect of aorta-iliac bypass total thoracoabdominal aorta aneurysm repair to spinal cord function

作　　者：段玉印[1] 郑军[1] 潘旭东[1] 朱俊明[1] 刘永民[1] 葛翼鹏[1] 程力剑[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,100029

出　　处：《中华外科杂志》2016年第5期380-383,共4页Chinese Journal of Surgery

基　　金：国家卫生和计划生育委员会公益性行业科研专项项目（201402009）;北京市科学技术委员会国家国际科技合作与交流专项项目（2012DFA31110）;首都卫生发展科研专项资助项目（首发201l-2006-05）

摘　　要：目的探讨主动脉-髂动脉旁路全胸腹主动脉替换术对脊髓功能的影响。方法本研究为前瞻性研究。选择2014年6月至2015年4月于首都医科大学附属北京安贞医院心脏外科接受主动脉．髂动脉旁路全胸腹主动脉替换术的31例患者，男性23例，女性8例，平均年龄（36±12）岁。应用四分支人工血管，先建立主动脉-髂动脉旁路，通过人工血管旁路，逆行灌注内脏动脉、脊髓节段动脉；然后分段替换病变的胸降主动脉和腹主动脉。术中应用诱发电位监测脊髓功能变化，根据术中诱发电位结果和临床结果及术后短期随访结果，评价该术式对脊髓的影响。结果诱发电位在主动脉近端阻断后消失，运动诱发电位消失（56±18）min，体感诱发电位消失（50±19）min。诱发电位在脊髓节段动脉重建后逐渐恢复，所有病例诱发电位均恢复正常。2例患者体感诱发电位始终无变化（假阴性）。术后死亡1例；发生急性肾功能不全3例，肺出血1例，无脊髓缺血损伤发生。术后随访1～11个月（平均8个月），无迟发性脊髓损伤发生。结论主动脉-髂动脉旁路全胸腹主动脉替换术中，脊髓功能有一个短暂可逆的缺失过程。主动脉-髂动脉旁路术式对脊髓的影响是可以接受的。Objective To evaluate the effect of aorta-iliac bypass total thoracoabdominal aorta aneurysm repair to spinal cord function. Methods This was a prospective study. From June 2014 to April 2015, 31 patients underwent total thoracoabdominal aorta anenrysm repair were treated with aorta-iliac bypass technique. There were 23 male and 8 female patients with a mean age of （36 ± 12 ） years. A 4- branched tetrafurcate graft was used. The aorta-iliac bypass was established, then distal descending aorta was perfused in a retrograde fashion via bypass graft. Thoracic and abdominal aorta were replaced in a staged fashion. Evoked potentials （EP） monitoring was adopted to assess the spinal cord ischemia throughout the procedure. The intraoperative evoked potentials results, clinical outcomes and follow-up results of this technique were evaluated. Results The EP wave disappeared after proximal descending aorta clamped and gradually recovered after the patent segmental arteries reattached. Motor evoked potentials disappeared for （56± 18） minutes, somatosensory evoked potentials disappeared for （50 ± 19） minutes. The EP wave was restored to normal at the end of operation in all cases. The somatosensory evoked potentials remained unchanged in 2 cases （false negative）. One case died after operation. There were acute kidney dysfunction in 3 cases, and pulmonary haemorrhage in 1 case. No spinal cord injure occurred. The median follow-up after operation was 8 months （ranging from 1 to 11 months）. There was no delayed nenrologic deficit or relative death. Conclusions There is a transient function loss of spinal cord during the aorta-iliac bypass total thoracoabdominal aorta aneurysm repair. But the process is reversible. The technique of the aorta-iliac bypass is practicable.

关 键 词：主动脉疾病 脊髓损伤 诱发电位 

分 类 号：R654.3[医药卫生—外科学]