再次正中开胸的孙氏手术近中期临床结果  

Midterm clinical results of Sun's procedure with median resternotomy

作　　者：刘宁宁[1,2] 葛翼鹏 郑军[1] 王晓龙[1] 白涛[1] 里程楠[1] 乔志钰[1] 胡海瓯[1] 刘永民[1] 朱俊明[1] 孙立忠[1] Liu Ningning;Ge Yipeng;Zheng Jun;Wang Xiaolong;Bai Tao;Li Chengnan;Qiao Zhiyu;Hu Haiou;Liu Yongmin;Zhu Junming;Sun Lizhong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing Engineering Research Center for Vascular Prostheses,Beijing 100029,China;Department of Cardiac Surgery,Shanxi Cardiovascular Hospital,Taiyuan 030024,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、北京市大血管疾病诊疗中心、北京市大血管外科植入式人工材料工程技术研究中心、主动脉外科中心,北京100029 [2]山西省心血管病医院心外科,太原030024

出　　处：《中华胸心血管外科杂志》2023年第2期71-76,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京学者-孙立忠基金(2013-247)。

摘　　要：目的总结再次正中开胸行孙氏手术(全弓替换+支架象鼻置入术)治疗主动脉疾病的临床资料。方法回顾性分析2018年1月1日至2020年12月31日,在北京安贞医院主动脉外科中心接受再次正中开胸的孙氏手术的55例患者资料,其中男41例,女14例;年龄(45.4±12.7)岁。首次正中开胸手术的病因包括A型主动脉夹层、主动脉根部或升主动脉瘤、心脏瓣膜手术和冠状动脉旁路移植术。再次手术的指征残余主动脉夹层瘤样扩张,直径超过55 mm、主动脉瘤扩张、新发A型主动脉夹层,吻合口漏及假性动脉瘤。手术均在全麻,正中开胸下完成,顺行性单侧或双侧脑灌注完成支架象鼻置入和弓部替换手术。结果无术中死亡,术后死亡5例(9.1%,5/55),死亡原因为低心排血量综合征2例,呼吸功能衰竭、脑部并发症和消化道出血各1例。除死亡病例外,术后脑部并发症2例(2/50,4%),脊髓损伤(一过性截瘫)5例(5/50,10%);呼吸机辅助14~42 h,中位时间17 h,8例(8/50,16%)超过48 h;肾功能衰竭需要替代治疗2例。完成随访45例(90%),随访(25.9±11.2)个月(10~47个月),期间因脑并发症死亡1例,行全胸腹主动脉替换术4例,行吻合口漏修补术1例。结论再次正中开胸行全主动脉弓替换术+支架象鼻手术(孙氏手术)治疗复杂弓部病变安全有效。Objective To summarize the clinical data of Sun's procedure(total aortic arch replacement with frozen elephant trunk technique)in the treatment of complex aortic arch disease after previous cardiac surgery.Methods From January 1,2018 to December 31,2020,a total of 55 patients underwent resternotomy Sun's procedure in the Aortic Surgery Center of Beijing Anzhen Hospital,including 41 males and 14 females,with a mean age of(45.4±12.7)years old,were retrospectively analyzed.The indications of primary cardiac surgery included type A aortic dissection,aortic root or ascending aortic aneurysm,heart valve surgery,and coronary heart disease.Indications for reoperation included residual aortic dissection larger than 55 mm in diameter,aortic aneurysm dilation,new type A aortic dissection,anastomotic leakage with symptoms,and pseudoaneurysm.All the operations were performed under general anesthesia and median resternotomy,total aortic arch replacement with the stented elephant trunk implantation and were performed by anterograde unilateral or bilateral cerebral perfusion.Results There was no intraoperative death,and the postoperative mortality was 9.1%(5/55).The causes of death were 2 cases of low cardiac output,1 case of respiratory failure,1 case of cerebral complications,and 1 case of gastrointestinal bleeding.Except death,there were 2 cases of postoperative cerebral complications(2/50,4%),5 cases of spinal cord injury(transient paraplegia)(5/50,10%),the median duration of ventilator use was 17 hours(14-42 h).Other postoperative complications included respiratory insufficiency requiring ventilatory support longer than 48 hours(8/50,16%),renal insufficiency requiring temporary dialysis(2/50,4%).The follow-up time was(25.9±11.2)months(10-47 months),during which 1 case died due to cerebral complication,4 cases underwent total thoracoabdominal aorta replacement,and 1 case underwent anastomotic leakage repair.Conclusion It is safe and effec to perform Sun's procedure(total aortic arch replacement with frozen elephant trunk t

关 键 词：主动脉疾病 再次正中开胸 全主动脉弓替换术 支架象鼻 

分 类 号：R654.3[医药卫生—外科学]