急性A型主动脉夹层合并下肢缺血的治疗

Clinical treatment of acute type-A aortic dissection with lower limb malperfusion

目的探讨急性A型主动脉夹层合并下肢缺血的临床治疗方法。方法2012年12月至2016年12月，手术治疗急性A型主动脉夹层479例，其中39例合并下肢缺血。男27例，女12例；平均年龄（51．4±12．4）岁。所有患者在深低温停循环下行手术治疗，采用单泵双管上下肢分别灌注，根据患者下肢缺血时间、症状及体征，评估肢体缺血情况，必要时行股动脉一股动脉人工血管转流术，对于同期未行股动脉一股动脉人工血管转流患者，术后严密监测，必要时进行二期股动脉一股动脉人工血管转流或骨筋膜切开减压术。结果全组患者术后30天内死亡7例（17．9％，7／39），术后生存32例。术后30例（93．8％，30／32）随访3个月～3年，效果满意，29例（96．7％，29／30）随访患者下肢缺血症状改善。结论术前对患者进行全面评估，合理把握手术指征，积极手术治疗急性A型主动脉夹层合并下肢缺血是寄伞、有效的．必要时可同期行各娄转流手术雷律下肢向运．

Objective To explore the treatment experience of acute type-A aortic dissection with lower limb malperfu- sion. Methods From December 2012 to December 2016, 479 cases of acute type A aortic dissection were treated surgically, including 39 patients with lower limb ischemia, including 27 males and 12 females, with mean age of（51.4 ± 12.4 ） years. All patients were treated with deep hypothermic circulatory arrest and were treated with single pump, double-tube and double-injec- ted limbs. According to the patient＇s lower limb ischemia time, symptoms and signs, limb ischemia was assessed. If necessary, femoral artery-femoral arterial bypass was performed. For patients undergoing femoral arterial-femoral prosthetic bypass during the same period, postoperative follow-up monitoring, if necessary, secondary femoral-femoral arterial vascular bypass or osteo- fascial decompression. Results Early mortality rate was 17.9% （7/39）. 32 cases of postoperative survival. The follow-up rate was 93.8% （30/32）, 3 months to 3 years after the operation, the results were satisfactory. The over lower limb malperfusion recovery rate of follow-up patients was 96.7 % （ 29/30）. Conclusion Positive operation for acute type-A aortic dissection with lower limb malperfusion is safe, feasible and effective. Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary. Comprehensive evaluation of patient＇ s status is strongly recommended for optimal surgical deci- sion making.