分期全主动脉置换术治疗主动脉夹层动脉瘤

Treatment of Aortic Dissecting Aneurysm Using Staged Total Aortic Replacement

目的:探讨采用分期全主动脉置换术治疗主动脉夹层动脉瘤的手术方式和治疗效果。方法:对6例马凡氏综合征的患者行分期全主动脉置换术,手术方法为:经左侧胸腹联合切口、腹膜外入路,在体外循环或左心转流下采用分段阻断法完成胸腹主动脉置换及重要分支的重建。其中1例深体温停循环20 min。结果:所有患者均康复出院,平均体外循环或左心转流时间(202.0±54.1)min,呼吸机辅助通气时间10.5～200.0h,患者监护室入住时间3～12 d。术后出现急性肾功能损害2例,声音嘶哑2例,无脊髓损伤病例。1例术后2个月因脓胸病死。结论:分期全主动脉置换术是治疗主动脉夹层动脉瘤的一种安全、有效的方法。

Objective：To investigate the surgical techniques of staged total aortic replacement and its efficacy in treating aortic dissecting aneurysm. Methods： Six patients with Marfan syndrome underwent staged total aortic replacement. Through a tho- racoabdominal incision and retroperitoneal route, thoracoabdominal aorta and its main branches were reconstructed using the technique of ＂clamp and sew＂ under cardiopulmonary bypass（CPB） or left heart bypass. Only one patient could not avoid deep hypothermic circulatory arrest with a period of 20 minutes. Results： All procedures have been completed successfully without recent death. The duration of CPB or left heart bypass, the time for mechanical ventilation and the intensive care unit（ICU）re- tention was （32.5± 9.0） rain, 10.5-200.0 h and 3-12 days, respectively. Two patients had acute kidney damage, two pa- tients experienced hoarseness and no patient had spinal cord injury. One patient died two months after the surgery due to pyo- thorax. Conclusions： Staged total aortic replacement is a safe and effective treatment strategy in aortic dissecting aneurysm.