急性Stanford A型主动脉夹层术中渗血防治-单中心经验总结  

Prophylaxis of Anastomotic Errhysis in the Surgery of Acute Stanford Type A Aortic Dissection-Single Centre Experience

作　　者：陈良万[1] 林勇[1] 戴小福[1] 方冠华[1] 严亮亮[1] CHEN Liang-wan;LIN Yong;DAI Xiao-fu;FANG Guan-hua;YAN Liang-liang(Department of Cardiovascular Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院心脏外科,福建省福州市350001

出　　处：《中国心血管病研究》2019年第11期961-965,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的通过分析近年来收治的急性Stanford A型主动脉夹层病例,总结关于防治术中渗血的经验,为手术方案的改进提供临床依据。方法选取罹患急性Stanford A型主动脉夹层并接受升主动脉+主动脉弓修复手术的患者纳入本回顾性研究。主动脉根部处理采用内衬片法;弓部处理应用三分支支架血管或单分支支架血管联合头壁血管内小支架;体外循环则运用中低温停循环技术联合右腋动脉加股动脉双通道灌注法;内瘘技术采用改良包裹法。临床数据采集包括一般临床资料、病因、主动脉夹层破口位置和累及范围、术前合并症、心功能、手术情况及预后。结果共计178例患者纳入本研究,手术时间308±49.8min,体外循环时间131±23.9min,升主动脉阻断时间88.2±12.1 min,中低温停循环加选择性脑灌注时间21.5±6.7 min,术后心包腔引流液300±90 ml,住院死亡率5.6%,术后神经系统并发症发生率8.6%,出院后死亡率为0。术后3个月发现内瘘1例(0.5%),胸主动脉夹层愈合率79.8%;术后1年,未发现内瘘发生,胸主动脉夹层愈合率达82.7%;所有患者均未发现人造血管周围造影剂外渗。结论渗血仍是急性Stanford A型主动脉夹层常见的并发症。“新内膜技术”、中低温停循环联合双侧头臂干动脉灌注以及改良包裹内瘘法等多种技术的应用,有助于减少术中渗血,缩短手术时间,减少内瘘发生,提高胸主动脉夹层愈合率和患者总体生存率,改善预后。Objective:To summarize the prophylaxis of anastomotic errhysis in the surgery of acute Stanford type A aortic dissection(AAAD)by analysing the clinical data of latest cases,and to provide the clinical evidence for the modification of the surgical protocols.Methods:The patients with AAAD who underwent the repairing surgeries of ascending aorta and aortic arch were enrolled in this retrospective study.The modified valve-sparing aortic root replacement technique was applied in the remodeling of aortic root.Open single-branched or triple-branched stent graft placements were performed in the repairment of aortic arch.The moderate hypothermic circulatory arrest and the double channel perfusion of right axillary artery and femoral artery were applied in the process of the extracorporeal circulation.The technic of transverse pericardial sinus closure were used for autotransfusion of anastomotic errhysis.The general clinical data,the etiology,the location and the extent of the AAAD,the cardiac function,the surgical procedures and the prognosis were collected and analysed.Results:One hundred and seventy-eight patients were enrolled in this research.The mean duration of the surgery was 308±49.8 min.The mean duration of the extracorporeal circulation was 131±23.9 min.The mean duration of the acending aortic clamping was 88.2±12.1 min.The mean duration of the moderate hypothermic circulatory arrest combined with the selective cerebral perfusion was 21.5±6.7 min.The mean volume of the postoperative pericardial drainage was 300±90 ml.The mortality in-hosptial was 5.6%.The morbility of postoperative neural complications was 8.6%.No death was observed after hospital discharge.One case of endoleak was observed within one year after surgery,Disappearance of the false lumen and recovery of the true lumen was observed in 79.8%of the patients within 3 months and 82.7%of the patients within 1 year after the surgery.There was no blood flow or effusion surrounding the artificial vessel.Conclusions:Anastomotic errhysis was the most c

关 键 词：夹层动脉瘤 出血 深低温停循环 自体血回输 

分 类 号：R654.2[医药卫生—外科学]