弓部优先策略用于全胸主动脉置换术的近中期效果  

Application of branch-first technique in total thoracic aorta replacement:short and medium term effect of 11 cases

作　　者：闫小清[1] 武刚[1] 刘帅[1] 刘建华[1] 王平凡[1] 张瑞成[1] Yan Xiaoqing;Wu Gang;Liu Shuai;Liu Jianhua;Wang Pingfan;Zhang Ruicheng(Department of Cardiovascular Surgery,Henan Province Chest Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省胸科医院大血管外科,郑州450003

出　　处：《中华外科杂志》2022年第11期1018-1022,共5页Chinese Journal of Surgery

基　　金：河南省医学科技攻关计划(LHGJ20210239)。

摘　　要：目的探讨弓部优先策略用于全胸主动脉置换的近中期效果。方法回顾性分析2018年1月至2021年7月在河南省胸科医院大血管外科接受治疗的11例Stanford A型主动脉夹层合并CrawfordⅠ或Ⅱ型全胸腹主动脉瘤患者的临床资料。男性7例,女性4例,年龄(38±5)岁(范围:28~45岁)。7例为马方综合征,1例为主动脉缩窄。手术均采用浅低温弓部优先策略,首先经胸部正中小切口联合左后外侧第6肋间切口,其次应用四分支人工血管与头臂动脉端端吻合保证脑部供血,阻断循环后行心内及主动脉近端操作,开放循环后完成肋间动脉重建及胸降主动脉置换。结果手术时间(645.9±91.7)min(范围:505~840 min),术后发生脑栓塞1例,乳糜胸1例,经保守治疗后好转。所有患者均治愈出院。随访4~47个月,1例于术后3个月因腹主动脉瘤进展行胸腹主动脉+髂动脉切除并置换,2例肋间动脉管道堵塞,余生活质量良好。结论采用弓部优先策略一期行全胸主动脉置换手术风险可接受,近中期效果满意,无分期手术中残余主动脉瘤破裂的风险,是治疗年轻且器官功能良好的复杂主动脉病变的有效方法。Objective To examine the short and medium term effect of branch-first technique in total thoracic aorta replacement.Methods The clinical data of eleven patients with ascending aortic aneurysms or type A aortic dissection+CrawfordⅠorⅡtotal thoracoabdominal aortic aneurysm who were treated at Department of Cardiovascular Surgery in Henan Province Chest Hospital from January 2018 to July 2021 were retrospectively analyzed.There were 7 males and 4 females,aging(38±5)years(range:28 to 45 years),7 cases of whom were diagnosed with Marfan syndrome,1 case was diagnosed with coarctation of aorta.Operations were performed under mild hypothermic and branch-first technique.Firstly,the middle and small incision in the chest was combined with the 6th intercostal incision in the left posterior lateral side.Secondly,four branches artificial blood vessels were anastomosed with the brachiocephalic artery to ensure the blood supply to the brain.After the circulation was blocked,intracardiac and aortic proximal operations were performed.Intercostal artery reconstruction and thoracic descending aorta replacement were completed after opening circulation.Results The operative time of this group was(645.9±91.7)minutes(range:505 to 840 minutes).One case had cerebral infarction and 1 case had chylothorax.The patients were followed up 4 to 47 months,1 patient underwent thoracic and abdominal aorta+iliac artery resection and replacement due to the progression of abdominal aortic aneurysm 3 months after operation.Intercostal artery obstruction occurred in 2 cases,and the rest lived well.Conclusions One-stage whole thoracic aorta replacement with branch-first technique has satisfactory results in the short and medium term,with no risk of residual aortic aneurysm rupture.It is an effective treatment for young and organs function well patients with complex aortic lesions.

关 键 词：主动脉瘤 动脉瘤 夹层 全胸主动脉置换 

分 类 号：R654.3[医药卫生—外科学]