Stanford A型主动脉夹层手术中股动脉插管的应用

Femoral cannulation in Stanford Type A aortic dissection operations

目的 :探讨经股动脉插管行主动脉夹层动脉瘤手术的应用。方法 :88例StanfordA型主动脉夹层动脉瘤经股动脉插管建立体外循环进行手术 ,其中 2 6例深低温停循环。结果 :8例 (9. 1% )在术中出现假腔灌注 ;4例 (4. 5 % )脑部并发症 (2例广泛脑缺氧 ,2例脑栓塞 ) ,2例死亡 ,1例不清醒 ,1例偏瘫 ;6例 (8. 0 % )皮肤切口延迟愈合 ,局部感染 1例 (1.3% )。术后插管侧无下肢缺血或股动脉血栓形成。结论 :经股动脉插管行体外循环或左心转流手术治疗主动脉夹层动脉瘤的方法是有效的。采用经人工血管行股动脉插管可有效的降低了股动脉狭窄、血栓形成和下肢缺血的并发症发生率 ;股动脉插管主动脉逆行灌注造成的假腔灌注和脑部并发症在本组发生率虽较低 ,但后果严重。

Objective：To Evaluate the effect of femoral artery cannulation in aortic dissection operations. Method： From May 1994 to December 2001, 88 patients underwent operation with cardiopulmonary bypass for Stanford type A aortic dissection and perfused through femoral artery. 31 patients had deep hypothermic circulatory arrest. Resuit：False lumen perfusion was detected during cardiopulmonary bypass in eight patients （9.1%）. There were four patients （4.5%） with cerebral events（two patients with diffused cerebral injury with one death , two patients with hemiplegia with one deaths）. Prolonged incision recovery were occurred in six patients （8,0%）, and one local infections. There was no lower extremity ischeamia associated with femoral cannulation after usage of cannulating through a graft. Conclusion：Arterial perfusion through femoral artery for repair of aortic dissections is effective. There was no lower extremities ischeamia occurred with the technique of femoral cannulation into the graft. Retrograde perfusion through femoral cannulation provides a low risk of cerebral events and false lumen perfusion with high mortality.