左颈位主动脉弓动脉瘤的外科治疗

Surgical repair of left-sided cervical aortic arch aneurysm

目的：总结颈位主动脉弓（cervical aortic arch，CAA）动脉瘤的外科治疗方法及术后早中期效果。方法2010年1月至2014年12月，收治22例CAA动脉瘤患者，均为左位CAA。其中男6例，女16例，年龄（34.09±13.14）岁。术前合并主动脉假性狭窄9例，高血压3例，主动脉瓣反流、Stanford B型主动脉夹层、大脑中动脉瘤各1例。所有患者均采用人工血管替换术行主动脉弓重建。4例（4／22，18.18％）经胸骨正中切口，中度低温停循环、选择性顺行脑灌注下手术，其中同期行主动脉瓣置换术1例；18例（18／22，81.82％）经左后外侧第4肋间切口手术，其中10例体外循环辅助下实施手术，8例直接阻断下手术。结果全组平均呼吸机辅助（13.05±4.73） h，ICU停留（19.14±8.08） h。术后二次开胸止血1例，切口延迟愈合1例，一过性肝功能不全1例。无院内死亡。术后19例随访平均34.73个月，失访3例。随访期间无死亡。结论 CAA动脉瘤患者应积极手术治疗。根据CAA动脉瘤的位置、类型以及合并的其他近端心血管疾病，选择个体化的手术切口、辅助技术及手术方法，一期行主动脉弓重建手术治疗CAA动脉瘤可获得满意的临床效果。

Objective To summarize our experience of surgical repair for cervical aortic arch（CAA） aneurysm and eval-uate early and midterm results of these patients.Methods From January 2010 to December 2014, 22 patients with left-sided CAA aneurysm admitted in our center.There were 6 male and 16 female patients with a mean age of（34.09 ±13.14） years. Comorbidities included pseudocoarctation in 9 patients, hypertension in 4 patients, and aortic valve insufficiency, Stanford type B aortic dissection and middle cerebral artery aneurysm each had 1 patient.All of the patients underwent surgical aortic arch re-construction using artificial graft replacement.Among them, 4（4/22, 18.18%） were performed under moderate hypothermic circulatory arrest（MHCA） combined with selective antegrade cerebral perfusion（SACP） via a median sternotomy, and concom-itant aortic valve replacement（AVR） was implemented in 1 patient.18（18/22, 81.82%） were performed via posterolateral left thoracotomy through the 4th intercostal space, and adjunct methods applied included partial CPB and “simple clamping” in 10 and 8 of these patients respectively.Results The average mechanical ventilation time and ICU stay time was （13.05 ± 4.73）h and（19.14 ±8.08） h respectively.1 patient required repeat thoracotomy for bleeding, 1 patient with delayed wound healing and 1 patient suffered transient liver dysfunction.There were no in-hospital deaths.Mean follow-up time was 34.73 months, and 3 patients were lost during follow-up.There were no late deaths during follow-up.Conclusion Repair of CAA is indicated for the patients with arch aneurysm formation .According to the locations and types of aneurysms and other concomi-tant proximal cardiovascular diseases, performing one-stage surgical aortic arch reconstruction with individualized incisions , ad-junct methods and operative procedures can obtain satisfactory clinical outcomes in patients with CAA aneurysm .