复杂主动脉缩窄的外科治疗  

Surgical strategy for treatment of complex aortic coarctation

作　　者：徐骁晗 吾米提 詹发亮 叶涛 高熠洲 顾卫东 顾群 邵永丰 XU Xiaohan;WU Miti;ZHAN Faliang;YE Tao;GAO Yizhou;GU Weidong;GU Qun;SHAO Yongfeng(Department of Cardiovascular Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing,210029,P.R.China;The Friendship Hospital of Ili Kazakh Autonomous Prefecture,Ili,835000,Xinjiang,P.R.China;Ili&Jiangsu Joint Institute of Health,Ili,835000,Xinjiang,P.R.China)

机构地区：[1]南京医科大学第一附属医院心脏大血管外科,南京210029 [2]新疆维吾尔自治区伊犁哈萨克自治州友谊医院,新疆伊犁835000 [3]伊犁州临床医学研究院,新疆伊犁835000

出　　处：《中国胸心血管外科临床杂志》2024年第5期776-781,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：新疆维吾尔自治区科学技术厅自然科学计划面上项目(2021D01A186);伊犁哈萨克自治州科技计划项目(YZ2021YD030);伊犁州临床医学研究院科研课题(yl2020lh02)。

摘　　要：目的总结解剖外旁路移植技术及解剖矫正技术治疗复杂主动脉缩窄的临床经验。方法回顾性分析2012年4月—2020年11月南京医科大学第一附属医院和伊犁哈萨克自治州友谊医院收治的复杂主动脉缩窄患者的临床资料。结果共纳入12例患者,其中男5例、女7例,年龄11~54(34.3±16.2)岁。8例采用解剖外旁路移植技术,4例采用解剖矫正技术。全组患者手术成功,无围术期死亡,平均心肺转流时间(203.0±46.0)min(7例正中切口患者),平均术中出血量(665.0±102.0)mL。术后平均呼吸机辅助时间(32.3±7.5)h,术后平均住院时间(10.2±4.3)d。正中切口术后平均引流量(1580.0±360.0)mL,平均引流管留置时间(9.3±2.7)d;左侧开胸切口平均引流量(890.0±235.0)mL,平均引流管留置时间(4.8±2.5)d。1例术后出现一过性声音嘶哑,术后半年恢复。随访2~10年,平均随访(81.0±27.0)个月,所有患者术后2年高血压得到改善,心脏负荷减轻。1例人造血管置换患者术后3年出现狭窄复发,其余患者随访无再狭窄,无死亡及其他并发症。结论复杂主动脉缩窄需根据狭窄的解剖特点,是否合并心脏疾病同期处理等情况个体化制定治疗方案,解剖外旁路移植技术安全可行。Objective To summarize the clinical experience of the treatment for complex aortic coarctation with extra anatomic bypass and anatomic correction techniques.Methods The clinical data of patients with complex aortic coarctation treated in the First Affiliated Hospital of Nanjing Medical University and Friendship Hospital of Ili Kazakh Autonomous Prefecture between April 2012 and November 2020 were retrospectively reviewed.Results A total of 12 patients were enrolled,including 5 males and 7 females aged 11-54(34.3±16.2)years.Extra anatomic bypass grafting was performed in 8 patients and anatomic correction was performed in 4 patients.The operations were successful in all patients.There was no perioperative death.The average cardiopulmonary bypass time was 203.0±46.0 min(7 median incision patients),and the average intraoperative blood loss was 665.0±102.0 mL.The average postoperative ventilator support time was 32.3±7.5 h,and the average postoperative hospital stay time was 10.2±4.3 d.The mean drainage volume of median incision was 1580.0±360.0 mL,and the mean drainage time was 9.3±2.7 d.The mean drainage volume of left thoracotomy was 890.0±235.0 mL,and the mean drainage time was 4.8±2.5 d.One patient had a transient hoarse after operation and recovered 6 months later.The follow-up period ranged from 2 to 10 years with an average time of 81.0±27.0 months.All patients had a recovery of hypertension,cardiac afterload after 2 years postoperatively.One patient who received an artificial blood vessel replacement in situ was examined stenosis recurrence at the third year after discharge.Others were asymptomatic during the follow-up period.There were no death or other complications.Conclusion The treatment strategy for complex aortic coarctation should be individualized according to the anatomical features andconcomitant heart diseases. Extra anatomic bypass technique is a safe and feasible choice.

关 键 词：复杂主动脉缩窄 解剖外旁路移植 解剖矫正 

分 类 号：R654.2[医药卫生—外科学]