“J”形与“L”形胸骨上段小切口入路在接受全弓置换术联合冰冻象鼻技术的急性A型主动脉夹层患者中的应用  

Cinical results of L-and J-shaped minimally invasive approach in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection

作　　者：杨忠路 刘宇 葛玉光 姜辉 YANG Zhong-lu;LIU Yu;GE Yu-guang;JIANG Hui(Department of Cardiovascular Surgery,General Hospital of Northern Theater 110016,China)

机构地区：[1]北部战区总医院心血管外科,辽宁沈阳110000

出　　处：《创伤与急危重病医学》2024年第6期336-340,共5页Trauma and Critical Care Medicine

摘　　要：目的探讨“J”形与“L”形胸骨上段小切口在接受全主动脉弓置换术(TAR)联合冰冻象鼻技术(FET)的急性A型主动脉夹层(ATAAD)患者中的应用评估。方法选取2019年12月至2020年10月于北部战区总医院手术的74例经CTA诊断为ATAAD并接受TAR联合FET的患者,男性52例,女性22例,年龄(52.3±10.2)岁,年龄范围为29~71岁。根据患者手术时间的不同将患者分为J组(n=43,于2019年12月至2020年5月期间手术)与L组(n=31,于2020年6月至2020年10月期间手术)。J组患者术中采用“J”形胸骨上段小切口,L组患者术中采用“L”形胸骨上段小切口。比较两组患者术中变量水平、动脉灌注位置、术中外科操作情况、术后住院情况、随访情况及病死情况。结果J组与L组患者体外循环时间、主动脉阻断时间、停循环时间、最低鼻咽温水平、术中动脉灌注位置(无名动脉、右锁骨下动脉、右颈总动脉、左颈总动脉)、术中外科操作情况(主动脉瓣悬吊成形、主动脉瓣置换、Bentall手术、体外膜肺氧合)、呼吸机辅助时间、ICU停留时间、术后24 h引流量、术后输血、二次机械通气、永久性神经功能缺损、急性肾衰竭、术后住院时间、住院费用比较,差异均无统计学意义(P>0.05)。J组体外循环建立时间短于L组、患者随访率低于L组、患者随访时间长于L组,差异均有统计学意义(P<0.05)。治疗期间及随访期间,两组患者病死率比较,差异均无统计学意义(P>0.05)。结论采用“J”形或“L”形胸骨上段小切口入路进行TAR联合FET治疗ADAAT患者是可行且安全的,J型切口可能对单一小切口入路下手术操作有优势,建立体外循环时间更短。Objective To compare the clinical results of L-and J-shaped minimally invasive approach in total arch replacement(TAR)combined with frozen elephant trunk(FET)for acute type A aortic dissection(ATAAD).Methods A total of 74 consecutive patients with ATAAD who underwent TAR with FET implantation diagnosed by CTA between December 2019 and October 2020 in the General Hospital of the Northern Theater Command.There were 52 males and 22 females,aged(52.3±10.2)years old,ranging from 29 to 71 years old.Patients were divided into the J-group(n=43,surgery was performed between December 2019 and May 2020)and the L-group(n=31,surgery was performed between June 2020 and October 2020).In the J-group,J-shaped upper hemisternotomy was used,and L-shaped upper hemisternotomy was used in the L-group.The two groups were compared with the intraoperative variables level,arterial perfusion location,intraoperative surgical procedures,postoperative hospitalization,follow-up,and mortality.Results The cardiopulmonary bypass time,aortic blocking time,circulatory arrest time,minimum nasopharyngeal temperature,arterial perfusion location,(innominative artery,right subclavicular artery,right common carotid artery,left common carotid artery),surgical procedures(aortic suspension plasty,aortic valve replacement,Bentall,extracorporeal membrane oxygenation),ventilation time,ICU stay time,24 hours chest tube drainage,blood transfusion,reventilation,permanent neurological deficit,acute renal failure,postoperative hospitalization time and hospitalization cost was compared in two groups,the differences were not statistically significant(P>0.05).The establishment time of cardiopulmonary bypass in J-group was shorter than that in L-group,the follow-up rate was lower than that in L-group,and the follow-up time was longer than that in L-group,the difference was statistically significant(P<0.05).There was no significant difference in mortality between the two groups during treatment and follow-up(P>0.05).Conclusions TAR with FET implantation is feasible and

关 键 词：主动脉夹层 全主动脉弓置换 微创 胸骨上段小切口 冰冻象鼻技术 

分 类 号：R654[医药卫生—外科学]