食管超声心动图引导经胸微小切口封堵主动脉夹层可行性分析  

Feasibility of transesophageal echocardiography-guided transthoracic micro-incisions for the treatment of aortic dissection

作　　者：张丽华 孙志超[2] Zhang Lihua;Sun Zhichao(Department of Ultrasonography,Zhejiang Provincial Hospital of Chinese Medicine,Hangzhou 310018,Zhejiang Province,China)

机构地区：[1]浙江省中医院超声科,杭州310018 [2]浙江省中医院医学影像科,杭州310018

出　　处：《中国基层医药》2021年第8期1150-1153,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省公益技术应用研究计划项目(LGD19C040002)。

摘　　要：目的:分析术中经食管超声心动图(TEE)引导经胸微小切口封堵主动脉夹层的可行性。方法:选取浙江省中医院2017年3月至2019年3月手术前行TEE检查的主动脉夹层患者10例,将患者分为A组(累及主动脉5例)和B组(主动脉弓部溃疡5例);分析两组患者手术前后的诊断情况,引导鞘管、导丝在手术中快速进入夹层情况,并观察封堵器的稳定性、位置、对血流的局部影响。结果:两组患者经过TEE检查发现,封堵治疗的效果较好,在其引导下可以成功将主动夹层破口封堵。A组患者主动脉夹层的破口被封堵后消失,被累及的夹层假腔形成血栓,血流速度由230 cm/s减为120 cm/s。B组患者主动脉管壁与封堵器紧密结合后破口消失,主动脉弓部的血流速度为120 cm/s,封堵前后封堵器具有稳定性,并且对血流的局部无明显影响,术后40 d复查,封堵器位置无偏移现象。结论:主动脉夹层患者手术前进行TEE检查,可有效地观测患者的病变程度,避免漏诊;在手术中可准确引导手术者放置封堵器;完成手术后,能够精确评估患者的手术效果。Objective To investigate the feasibility of transesophageal echocardiography(TEE)-guided transthoracic micro-incisions for the treatment of aortic dissection.Methods Ten patients with aortic dissection who received TEE before surgery between March 2017 and March 2019 in Zhejiang Provincial Hospital of Chinese Medicine,China were included in this study.They were divided into group A(involving the aorta,n=5)and group B(aortic arch ulcer,n=5).Diagnosis before and after surgery was analyzed in each group.Whether guide sheath tube and guide wire rapidly entered the interlayer during the surgery was assessed.In addition,the stability and position of the occluder device and its effect on local blood flow were assessed.Results TEE findings revealed that occlusion treatment was effective and TEE-guided transthoracic micro-incisions successfully occluded the breaks of the aortic dissection.In group A,the occluded breaks of the aortic dissection disappeared,and thrombi formed in the false lumen.Blood flow velocity decreased from 230 cm/s to 120 cm/s.In group B,aortic wall was tightly bounded to the occluder device and the breaks disappeared.The velocity of the blood flow in the arch of the aorta was 120 cm/s.The occluder device was stable before and after occlusion.It had no effect on the velocity of local blood flow.At 40 days after surgery,the position of the occluder was not deviated.Conclusion TEE before surgery for aortic dissection can effectively assess the injury degree and avoid missed diagnosis.TEE can guide the placement of the occluder device during the surgery.TEE can also help accurately assess the surgical outcomes.

关 键 词：超声心动描记术 经食管 主动脉疾病 主动脉夹层 封堵术 间隔封堵器 搏动血流 诊断 技术评估 生物医学 

分 类 号：R654.3[医药卫生—外科学]