近5年单中心胸腹主动脉瘤外科手术治疗结果分析  

Analysis of surgical results of single-center thoracoabdominal aortic aneurysm in the past 5 years

作　　者：孙科雄 张力[1] 高夏[1] 崔聪[1] 张向辉 肖长波[1] 张亚飞 武刚[1] 王平凡[1] SUN Kexiong;ZHANG Li;GAO Xia;CUI Cong;ZHANG Xianghui;XIAO Changbo;ZHANG Yafei;WU Gang;WANG Pingfan(Department of Cardiovascular Surgery 8^th Word,Henan Province Chest Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省胸科医院心血管外科八病区,450003

出　　处：《心肺血管病杂志》2020年第8期952-957,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析单中心胸腹主动脉置换术的治疗效果,提高对开放外科手术治疗的信心。方法:回顾分析2014年10月至2019年10月,本中心58例胸腹主动脉瘤患者的临床资料,全组均行开放外科手术治疗。男性39例,女性19例;年龄23~67岁,平均(45.31±10.30)岁。Crawford分型Ⅰ型17例,Ⅱ型36例;瘤体最大直径50~120 mm,平均(65.16±12.69)mm;马方综合征29例,动脉粥样硬化25例,主动脉缩窄4例。采用Kaplan-Meier法对术后患者进行生存分析。结果:全组患者术中无死亡,术后早期死亡3例,死亡率为5.2%,1例因脑出血死亡,2例死于多器官衰竭;截瘫2例;肾衰竭8例,行CRRT治疗后痊愈;脑部并发症4例,1例为脑出血,3例为缺血缺氧性脑病;肺部并发症13例,其中气管切开5例;胃肠道并发症2例,均为消化道出血;再次探查止血5例。共随访55例,随访时间4~63个月,平均24.27个月。出院后11个月、20个月,35个月各有1例患者死亡。本组患者的生存时间为(55.99±2.36)个月(95%CI:51.36~60.61)。结论:随着手术技术的改进、终末器官灌注的重视,作为一个治疗胸腹主动脉瘤手术量不大的中心,我们当代的治疗效果良好;对比血管腔内治疗,开放外科手术仍然是TAAA患者首选的治疗方式。Objective: Open surgical repair of thoracoabdominal aortic aneurysm continues to be challenging, with a high incidence of complications and early,postoperative mortality. This study analyzes the effects of contemporary single-center thoracoabdominal aortic replacement, in order to improve confidence in open surgical treatment. Methods: From October 2014 to October 2019, the clinical data of 58 patients with thoracoabdominal aortic aneurysm in our center were retrospectively analyzed. All the groups underwent open surgery. There were 39 males and 19 females, aged 23-67 years, with an average age of(45.31±10.30) years. There were 17 patients of CrawfordⅠand 36 patients of CrawfordⅡ. The maximum diameter of the aneurysm was 50-120 mm, with an average of(65.16±12.69) mm. There were 29 patients of Marfan syndrome, 25 patients of atherosclerosis, and 4 patients of aortic constriction. Kaplan-Meier method was used to perform survival analysis. Results: No patients died during the operation. Early mortality rate was 5.2%. Among them, 1 patient died of cerebral hemorrhage and 2 patients died of multiple organ failure. Paraplegia occurred in 2 patients. 8 patients of renal failure were treated with CRRT, who were all cured before leaving hospital. The incidence of cerebral complications was 6.9%. One of them had cerebral hemorrhage and three of them had ischemic hypoxic encephalopathy. The incidence of pulmonary complications were 22.4%, including 5 cases of tracheotomy. The incidence of gastrointestinal complications were 3.4% and all of them were gastrointestinal bleeding. 5 patients of hemostasis were explored again. All discharged patients were followed, and the mean follow-up time was 24.27(4-63)months. The mean survival time in this group is(55.99±2.36)months(95% CI: 51.36-60.61). Conclusions: With the improvement of surgical techniques and the emphasis on terminal organ perfusion, surgical repair can be accomplished in a non-high-volume center with acceptable result. Compared with aortic endovascular therapy,

关 键 词：胸腹主动脉瘤 胸腹主动脉置换术 

分 类 号：R54[医药卫生—心血管疾病]