解剖外人工血管旁路移植治疗复杂主动脉缩窄性病变  

Extra-anatomic bypass for complex aorta coarctation

作　　者：薛云星[1] 周庆[1] 朱悉煜 王东进[1] Xue Yunxing;Zhou Qing;Zhu Xiyu;Wang Dongjin(Department of Cardiac and Thoracic Surgery,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,210008

出　　处：《中华胸心血管外科杂志》2018年第8期461-464,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的应用解剖外人工血管旁路移植治疗合并心脏病变或存在主动脉多处严重缩窄的复杂血管缩窄性病变，探讨其安全性和可行性。方法复杂血管缩窄性病变常常合并心脏病变（瓣膜病、冠心病等），或胸腹主动脉多处缩窄性病变或弓部缩窄前后形成动脉瘤，多数无法行介入手术或侧开胸开放手术。2016年10月至2017年10月手术治疗6例复杂血管缩窄性病变患者，其中男3例，女3例；平均年龄（50．0±17．9）岁。缩窄位于主动脉弓峡部4例，腹主动脉1例，同时累及主动脉弓峡部和腹主动脉1例。应用一期解剖外人工血管旁路建立升主动脉至远端主动脉的血管旁路，经正中开胸同时从后下侧心包显露胸降主动脉行人工血管旁路移植手术4例，经胸腹联合切口显露腹主动脉行人工血管旁路移植手术1例，经腹腔镜引导在双侧腹股沟切口与双侧股动脉行人工血管旁路移植手术1例。同期行瓣膜手术3例，冠状动脉旁路移植手术1例。结果手术无死亡。平均体外循环时间273．8min，平均主动脉阻断时间216．0min。术后患者四肢血压压差较术前显著减小，临床症状显著改善。随访人工血管通畅，症状缓解。结论应用解剖外人工血管旁路治疗复杂血管缩窄性病变安全有效，并不会增加手术风险。Objective To evaluate the safety and feasibility of extra-anatomic bypass in the treatment of complex aorta coarctation concomitant with cardiac lesions, multiple stenosis of aorta or severe stenosis. Methods Complex aorta coarctafion include a combination of heart disease（ valve disease, coronary artery disease, ect. ）, or multiple constrictive lesions of the tho- racic abdominal aorta or an aneurysm due to constriction of the arch, which are all difficult by interventional surgery or open thoracotomy surgery. From October 2016 to October 2017, 6 patients with complex aorta coarctation have received surgical ther- apy in our department, including 3 males and 3 females, with the average age（ 50.0 ± 17.9 ） years old. One-staged extra-ana- tomic bypass was used to establish an ascending aorta to the distal aorta bypass , 4 patients underwent median thoraeotomy and bypass surgery with thoracic aorta from the posterior inferior pericardium, 1 patient underwent bypass surgery with abdominal a- orta through thoracoabdominal incision, and 1 patient underwent bypass surgery with bilateral femoral artery from bilateral in- guinal incision and guiding with laparoscopic through peritoneal cavity. Among them, 3 patients underwent valve surgery in the same period, and 1 patient underwent coronary artery bypass surgery. Results No patient died. The mean cardiopulmonary bypass time was 273.8 minutes and the average aorta blocking time was 216.0 minutes. Pulse pressure of extremities blood pressure was significantly reduced compared with preoperative, and the clinical symptoms were significantly alleviation. During follow-up, 6 patients presented with patent artificial blood vessels and alleviated symptoms. Conclusion Extra-anatomic by- pass is a safe and effective method for the treatment of complex vasoconstriction without increasing the risk of surgery.

关 键 词：主动脉缩窄 解剖外旁路 人工血管 

分 类 号：R654.2[医药卫生—外科学]