改良支架“象鼻”手术在B型夹层中的应用  

The application of modified stented“elephant trunk”procedure in type B aortic dissection

作　　者：赵宏磊 白涛[1] 薛金熔[1] 刘永民[1] 孙立忠[1] ZHAO Honglei;BAI Tao;XUE Jinrong;LIU Yongmin;SUN Lizhong(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所,北京市心肺血管疾病研究所心脏外科,北京大血管疾病诊疗中心,北京市大血管外科置入式人工材料工程技术研究中心,100029

出　　处：《心肺血管病杂志》2020年第4期421-423,427,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨改良支架"象鼻"手术在B型夹层中的应用。方法:纳入2019年1月至2019年9月,在北京安贞医院行改良支架"象鼻"手术的7例复杂型Stanford B型主动脉夹层患者,男性6例、女性1例,年龄29~50岁,平均(40.29±7.52)岁;所有患者均合并高血压,体质量60~110 kg,平均(91.43±17.73)kg,其中≥90 kg 5例。患者均在低温体外循环下,经主动脉弓切口置入支架型人工血管。术后出院前均复查主动脉CTA。结果:手术时间4.5~5.5 h,平均(4.86±0.38)h,体外循环时间129~163 min,平均(145±12.94)min,主动脉阻断时间32~59 min,平均(44.43±7.93)min,选择性脑灌注时间17~32 min,平均(24.29±4.50)min,脑灌注流量5~8 mL·min^-1·kg^-1,平均(6.71±1.38)mL·min^-1·kg^-1,深低温停循环鼻咽温23.5~26.8℃,平均(25.21±1.16)℃,深低温停循环左上肢血压20~31 mmHg,平均(25.58±4.65)mmHg,术中动脉插管位置:无名动脉人工血管+左锁骨下动脉人工血管插管4例,无名动脉人工血管+右股动脉+左锁骨下动脉人工血管插管3例,术后呼吸机辅助时间8~15 h,平均(10±2.65)h,监护室滞留时间1 d,术后住院时间6~8 d,平均(7.14±0.69)d,无手术死亡,支架周围假腔闭合率100%,股动脉切口延迟愈合1例,无吻合口漏,无神经系统并发症。结论:改良支架"象鼻"手术治疗复杂型Stanford B型主动脉夹层安全有效。Objective:To explore the application of modified stent elephant trunk(sET)procedure in complex Stanford type B aortic dissection(TBAD).Methods:From January 2019 to September 2019,7 patients with complex TBAD underwent modified sET procedure in Anzhen Hospital.There were 6 male and 1 female patients with their age 29-50(40.29±7.52).There were 7 patients with hypertension.All the patients received sET implantation via an aortic arch incision under deep hypothermic circulatory arrest.Computed tomography angiography(CTA)was performed before discharge for all the patients.Results:Operation time was 4.5-5.5(4.86±0.38)hours,cardiopulmonary bypass(CPB)time was 129-163(145±12.94)minutes,aortic cross-clamping time was 32-59(44.43±7.93)minutes,and selective cerebral perfusion(SCP)time was 17-32(24.29±4.50)minutes.SCP flow was 5-8(6.71±1.38)ml·kg^-1·min^-1 and nasopharyngeal temperature was 23.5-26.8(25.21±1.16)℃.The blood pressure of left upper limb was 20-31(25.58±4.65)mmHg while SCP.Aorta cannulation position:Vascular graft anastomosed with Innominate artery(IA)and vascular graft anastomosed with left subclavian artery(LSA)in 4 cases,vascular graft anastomosed with IA,vascular graft anastomosed with LSA and right femoral artery in 3 cases.Ventilation time was 8-15(10±2.65)hours,retention time in ICU was 1 day and postoperative hospitalization was 6-8(7.14±0.69)days.There were no death,no endoleakage and no neurological complications.Conclusions:The application of modified stented elephant trunk procedure in the treatment of TBAD is safe and effective.

关 键 词：改良支架“象鼻”手术 STANFORD B型主动脉夹层 

分 类 号：R54[医药卫生—心血管疾病]