经人工血管行股动脉插管在主动脉夹层手术中的应用

Clinical effect of femoral cannulation via arteficial vessel in operation for aortic dissection

目的 探讨经股动脉插管行主动脉夹层动脉瘤手术的结果。方法 对 1 59例主动脉夹层动脉瘤经股动脉插管进行手术 ,并观察其疗效。 1 59例主动脉瘤中 :StanfordA型 89例 ,StanfordB型70例。 90例全心转流 ,其中 31例深低温停循环 ,69例左心转流。结果 7例 (4 4% )在术中出现假腔灌注 ;7例 (4 4% )出现脑部并发症 ,4例死亡 ,2例广泛脑缺氧 ,5例脑栓塞 ;1 2例 (9 0 % )皮肤切口延迟愈合 ,局部感染 2例 (1 5 % )。无插管侧下肢缺血或股动脉血栓形成。采用经人工血管行股动脉插管有效地降低了股动脉狭窄、血栓形成和下肢缺血的发生率。股动脉插管主动脉逆行灌注造成的脑部并发症在本组发生率较低 ,但后果严重。

Objective To evaluate the effect of femoral cannulation via arteficial vessel in operation for aortic dissection. Methods Operation through femoral cannulation via artificial vessel was performed upon 159 patients with aortic dissection, 89 of Stanford type A and 70 of Stanford type B. An artificial vessel was anastomosed end to side to the femeral artery. Femoral catheter was inserted via this artificial vessel. Cardiopulmonary bypass was performed in 90 patients, among which 31 had deep hypothermic circulatory arrest. Left heart bypass was performed in 69 patients. Results False lumen perfusion was detected during cardiopulmonary bypass in 7 patients (4.4%). Cerebral events occurred in 7 patients (two patients with diffused cerebral anoxia with one death, and five patients with cerebral embolism with three deaths). 12 patients suffered from prolonged incision recovery (9.0%), and two from local infection (1.5%). No lower extremity ischeamia or femoral thrombosis was found in the cannulation side. Conclusion Femoral cannulation via arteficial vessel effectively reduces the incidence of strcture of femoral artery, thrombosis, and lower extrmity ischemia. Operation through femoral cannulation via arteficial vessel is very effective in treatment of aortal dissection. Only a few cases of cerebral events caused by retrograde perfusion through femoral cannulation occurred in this group, however, with high mortality.