山东医药2024，Vol.64Issue(21)：15-18,4.DOI:10.3969/j.issn.1002-266X.2024.21.004
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
Effect of distal aortic arch occlusion in total arch replacement and stent-graft elephant trunk surgery for patients with acute type A aortic dissection
摘要
Abstract
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.关键词
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Key words
arch blocking technique/distal aortic arch occlusion technique/total arch replacement/stent-graft el-ephant trunk surgery/moderate hypothermic circulatory arrest/acute type A aortic dissection分类
医药卫生引用本文复制引用
孔佳杰,李召彬,席树强,靳泽岳,杨帆,朱喆,柳磊..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[J].山东医药,2024,64(21):15-18,4.基金项目
河北省2024年度医学科学研究课题计划(20240447). （20240447）
