四分支人工血管置换术治疗主动脉弓部疾病

Surgical Treatment of Aortic Arch Diseases with Four Branches Aortic Graft

目的总结应用深低温停循环（DHCA）、顺行选择性脑灌注（ASCP）四分支人工血管置换术治疗主动脉弓部疾病的方法和经验。方法2004年9～12月，日本群马心血管病中心心血管外科应用四分支人工血管置换治疗主动脉弓部疾病12例，其中主动脉瘤7例（4例为升主动脉瘤累及主动脉弓部、3例为主动脉峡部瘤），主动脉夹层动脉瘤5例（DeBakeyⅠ型1例、DeBakeyⅡ型3例、DeBakeyⅢ型1例）。在深低温停循环下应用球囊灌注管对3个头臂动脉行选择性脑灌注，用四分支人工血管行主动脉弓置换；其中Bentall手术加主动脉弓部／右半弓置换各1例，全弓部置换3例，右半弓置换3例，弓降部置换4例；12例手术中2例行象鼻手术。结果全组12例患者恢复良好，无脑部及其它系统并发症发生。手术时间5．5±1．7h，术中深低温停循环时间42．2±12．9min；术中4例未输血；术后住院时间22．3±7．2d。结论顺行选择性脑灌注对脑保护安全可靠，应用四分支人工血管置换术治疗主动脉弓部疾病可缩短深低温停循环的时间，降低弓部置换手术的复杂程度。

Objective To summarize the methods and experiences of surgical treatment of aortic arch diseases with four branches aortic graft under deep hypothermia circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods In 2004 from September to December, surgical treatment of 12 patients with 7 aortic aneurysm（4 cases with ascending aorta and aortic arch aneurysm, 3 cases with aneurysm of aortic isthmus） and 5 aortic dissection（DeBakey Ⅰ 1 case, DeBakey Ⅱ 3 cases, DeBakey Ⅲ 1 case） were collected in Gunma Prefectural Cardiovascular Center. All operations were carried out under DHCA and ASCP, and four branches aortic graft were used to replace the aortic arch. The Bentall procedure, total and partial arch replacement and elephant trunk technique were undertaken in different patients. Results Total 12 patients recovered from the great vessel diseases smoothly without severe cerebral and other systematic complications, the time of operation was 5.5±1.7 h, the period of DHCA was 42.2±12.9min, 4 cases with no blood transfusion, the time of hospitalization was 22.3±7.2d. Conclusion ASCP is a safe. and effective method of cerebral protection during circulation arrest, and four branches aortic graft may shorten the time of DHCA and simplify the procedure of aortic arch replacement.