主动脉瘤/夹层手术远端吻合方法的改良及其效果比较

Improved methods and comparison with anastomosis of remote end on operation of aortic aneurysm or aortic dissection

目的 总结主动脉瘤及主动脉夹层手术远端吻合口吻合方法改良的经验.方法 2006年6月至2011年6月,对10例主动脉瘤/夹层手术患者的主动脉远端吻合口应用了单纯腔内覆膜支架置入、血管箍加残端全层翻转和血管箍加腔内覆膜支架置入三种改良吻合方法.患者年龄36～69（52.2±12.0）岁.Bentall手术5例、Bentall手术＋全主动脉弓置换2例、Bentall手术＋二尖瓣置换1例、单纯升主动脉置换＋二尖瓣及主动脉瓣置换1例、Cabrol手术1例.结果 应用单纯腔内覆膜支架置入后吻合法1例,恢复循环后吻合口出血部位较多,止血极其困难,术后患者死于大量失血.应用血管箍加残端全层翻转吻合法7例,恢复循环后吻合口少量出血3例,补针后均顺利止血.应用血管箍加腔内覆膜支架置入法2例,恢复循环后吻合口未见明显出血.结论 血管箍加主动脉残端全层翻转吻合法有较好的预防主动脉远端吻合口出血的效果,出血时补针亦易成功.血管箍加腔内覆膜支架置入法预防主动脉吻合口出血效果最为可靠,适合于各种类型主动脉瘤或主动脉夹层主动脉壁菲薄、脆弱者.

Objective To discuss the experience of aortic anastomosis of remote end on operation of aortic aneurysm or aortic dissection. Methods From June 2006 to June 2011, 10 patients with aortic aneurysm or aortic dissection underwent aortic replacement. Improved methods on aortic anastomosis of remote end included： anastomosis of alone cavity stents, anastomosis of vascular hoop and everting aortic wall, anastomosis of vascular hoop and cavity stents, aged 36-69 （52.2±12.0）. 5 cases with Bentall operation, 2 cases with Bentall operation and total aortic arch replacement, 1 case with Bentall operation and mitral valve replacement, 1 case with ascend- ing aorta replacement combined with aortic and mitral valve replacement, 1 case with Cabrol procedure. Results 1 case with the anastomosis of alone cavity stents, was found much bleeding on the aortic wall after anastomosis, and it was difficult to stop bleeding, the patient died of uncontrollable bleeding after operation. 7 cases with the anastomosis of vascular hoop and everting aortic wall, there were a few bleeding in 3 cases, but it was easy to stop bleeding. 2 cases with the anastomosis of vascular hoop and cavity stents, and there were almost no bleeding. Conclusion The anastomosis of vascular hoop and everting aortic wall is useful to prevent bleeding, it is easy to stop bleeding while bleeding on anastomosis. The anastomosis of vascular hoop and cavity stents is the best way to prevent bleeding, it is appropriate for the case whose aortic wall was thin and weak.