分支优先联合阻断弓部术中支架血管避免深低温停循环的全弓置换手术  

Total arch replacement without deep hypothermia or circulatory arrest: Clamping stented elephant trunk combined with the “branch-first” technique

作　　者：李勇[1] 张秀辉[1] 张玉春[1] 庞广辉[1] 马洪亮[1] 王庆欣[1] 孙念梓 LI Yong;ZHANG Xiuhui;ZHANG Yuchun;PANG Guanghui;MA Hongliang;WANG Qingxin;SUN Nianzi(Department of Cardiovascular Surgery, Linyi Municipal People＇s Hospital, Shandong Province, Linyi 276003, Chin)

机构地区：[1]临沂市人民医院心脏外科,276003

出　　处：《心肺血管病杂志》2018年第6期551-555,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:通过对全弓置换手术(孙氏手术)的改良,避免深低温停循环,以获得更好的早期临床效果。方法:2017年1月至2017年11月连续13例患者采用阻断弓部术中支架血管联合分支优先技术行全弓置换手术。右腋动脉和股动脉插供血管,单泵双管建立体外循环,首先以2分支人工血管先后吻合无名动脉和左颈总动脉建立持续双侧脑灌注,然后处理主动脉根部病变,在短暂停循环(1min左右)、中浅低温(鼻咽温28~30℃)下剖开主动脉弓部至无名动脉根部,置入术中支架血管,术中支架血管连同弓部血管一并阻断,恢复体外循环,继续完成重建手术。结果:13例患者均手术成功,全组平均下半身停循环时间(76±32)s,平均体外循环时间(213±28)min,平均主动脉阻断时间(105±22)min,手术后清醒时间(220±43)min,全组患者很快脱离呼吸机(25±17)h,无神经系统并发症发生,无肝肾功能损伤。结论:此改良全弓置换术式避免了深低温停循环,提供充分的大脑和内脏灌注,有效降低了神经系统并发症和内脏器官损伤。Objective： To achieve a better early clinical result by modifying the total arch replacement procedure（ Sun＇s operation） and avoiding hypothermia circulation arrest. Methods： From Jan. 2017 to Nov.2017,13 patients underwent the total arch replacement procedure by clamping aorta arch incorporating with stented elephant trunk（ Micro Port Medical Company Limited,Shanghai,China） combined with branch-first technique. Cardiopulmonary bypass（ CPB） was instituted via right femoral artery and right axillary artery cannulation. The innominate artery and the left carotid artery were anastomosed sequentially to the 2-branched prosthetic graft. The continued ante-grade bilateral flow to the cerebral was established. And then the aortic root reconstruction proceed as required. When the body temperature was cooled to 28-30℃,the circulation was arrested briefly（ 1 minunte or so）. The arch was opened to the root of the innominate artery,the stented elephant trunk was deployed into the arch and descending aorta. Then aorta arch incorporating with stented elephant trunk was clamped together. The CPB was resumed. And the reconstruction was continued to be completed.Results： All 13 operations were successful. The circulatory arrest time was（ 76 ± 32） s,the CPB time was（ 213± 28） min,the time of aorta blocking was（ 105 ± 22） min,the time of postoperative awakening was（ 220 ± 43）min,the time of assisted mechanical ventilator was（ 25 ± 17） h. The postoperative course was uneventful with no neurological complication or hepatic-renal impairment. Conclusion： The modified total arch replacement procedure can avoid deep hypothermia circulation arrest,provide continuous organ perfusion,and reduce the neurological and visceral damage.

关 键 词：主动脉外科 全弓置换 支架象鼻 停循环 中浅低温 

分 类 号：R54[医药卫生—心血管疾病]