急性A型主动脉夹层患者全弓替换加支架象鼻手术中远端主动脉弓部阻断的效果观察OACSTPCD
Effect of distal aortic arch occlusion in total arch replacement and stent-graft elephant trunk surgery for patients with acute type A aortic dissection
目的 观察急性A型主动脉夹层患者全弓替换加支架象鼻手术中实施远端主动脉弓部阻断的治疗效果.方法 急性A型主动脉夹层患者21例,均接受全弓替换加支架象鼻手术治疗,术中均采用远端主动脉弓部阻断技术阻断主动脉弓部,停循环温度为28℃中度低温.结果 21例患者均顺利完成手术治疗,手术时间(8.2±1.8)h,其中术中停循环时间(4.5±0.8)min、选择性脑灌注时间(42.5±9.6)min、术中体外循环时间(206.8±16.6)min、升主动脉阻断时间(135.7±22.0)min.21例患者中,19例患者治愈出院,2例患者术后死亡.治愈出院的19例患者中,2例患者出现术后并发症,1例因急性肾功能衰竭行床旁血滤治疗,1例因术后出血进行二次开胸止血.术后死亡的2例患者中,1例因冠脉事件死亡、1例因感染中毒性休克死亡.19例患者出院后复查主动脉CTA结果显示,支架人工血管通畅,未见钳夹损伤、变形或扭曲,远端吻合口附近无内漏形成,7例支架血管置入部位夹层假腔完全血栓化、11例部分血栓化、1例全程胸降主动脉和腹主动脉假腔完全血栓化.结论 在全弓替换加支架象鼻手术治疗急性A型主动脉夹层过程中,采用远端主动脉弓部阻断技术阻断主动脉弓部,可以避免深低温停循环,有效缩短了术中停循环时间,有助于减少术后并发症.
Objective To observe the therapeutic effect of distal aortic arch occlusion on patients with acute type A aortic dissection undergoing total arch replacement and stent-graft elephant trunk surgery.Methods Twenty-one pa-tients with acute type A aortic dissection all underwent total arch replacement and stent-graft elephant trunk surgery.Dur-ing the surgery,the distal aortic arch occlusion technique was used to block the aortic arch,with the circulatory arrest tem-perature at 28℃ moderate hypothermia.Results All 21 patients successfully completed the surgical treatment,with an average surgical duration of(8.2±1.8)h,including an intraoperative circulatory arrest time of(4.5±0.8)min,selec-tive cerebral perfusion time of(42.5±9.6)min,intraoperative extracorporeal circulation time of(206.8±16.6)min,and aortic cross-clamp time of(135.7±22.0)min.Among the 21 patients,19 were discharged after recovery,while 2 died postoperatively.Of the 19 patients who were discharged,2 experienced postoperative complications:one required bedside hemofiltration for acute renal failure,and one underwent re-thoracotomy for postoperative bleeding.Among the 2 patients who died postoperatively,one died from a coronary event,and the other from septic shock due to infection.Follow-up aortic CTA scans for the 19 discharged patients showed that the stent grafts were patent,with no signs of clamp injury,deformation,or torsion.There was no leakage near the distal anastomosis,and complete thrombosis of the false lumen at the stent graft implantation site was observed in 7 cases,partial thrombosis in 11 cases,and complete thrombosis of the en-tire descending thoracic and abdominal aorta in 1 case.Conclusion In the process of total arch replacement and stent-graft elephant trunk surgery for acute type A aortic dissection,the use of distal aortic arch occlusion technique to block the aortic arch can avoid profound hypothermic circulatory arrest,effectively reduce the duration of intraoperative circulatory arrest,and contribute to the decrease of postoperative complications.
孔佳杰;李召彬;席树强;靳泽岳;杨帆;朱喆;柳磊
河北医科大学第三医院心脏血管外科,石家庄 050000
临床医学
弓部阻断技术远端主动脉弓部阻断技术全弓替换手术支架象鼻手术中度低温停循环急性A型主动脉夹层
arch blocking techniquedistal aortic arch occlusion techniquetotal arch replacementstent-graft el-ephant trunk surgerymoderate hypothermic circulatory arrestacute type A aortic dissection
《山东医药》 2024 (021)
15-18 / 4
河北省2024年度医学科学研究课题计划(20240447).
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