人工血管套筒样翻转缝合加固在升主动脉近心端吻合的应用及效果

Applications of artificial blood vessel sleeve-like inverted suture reinforcement in proximal part of ascending aorta

目的总结人工血管套筒样翻转缝合加固在升主动脉近心端吻合中的临床经验,探讨该方法的有效性.方法回顾2017年8月至2018年4月10例需要行升主动脉置换的Stanford A型主动脉夹层患者资料,采用人工血管套筒样翻转缝合加固法施行近心端吻合,其中急诊手术9例.男8例,女2例;年龄43~69岁,平均(51±6)岁.患者术前均行主动脉全程CT增强扫描和经胸超声心动图检查.手术均采用深低温停循环和选择性脑灌注,术中人工血管向外翻转2 cm后套入升主动脉内,连续缝合人工血管翻转部分和自身升主动脉,如有明显渗血,在吻合圈的一侧或两侧置放人工血管条或心包条后缝合加固.观察术后24 h引流量和术后早期转归.结果全组无术中死亡,无二次开胸止血.术后24 h引流量150~880 ml,平均(260±55)ml.术后1例出现消化道出血,经床边胃镜两次止血后痊愈,2例出现术后暂时性神经系统并发症.10例患者经治疗后均痊愈出院.随访1~6个月,所有患者复查经胸超声心动图,其中8例复查CT血管造影,无新发主动脉瓣反流,未见明显窦部增宽.结论人工血管套筒样翻转缝合加固法吻合升主动脉近心端操作简单,缝合效果可靠,吻合圈及缝合针眼均和血流不直接接触,减少出血机会,即使少量渗血也容易发现和补针加固,该方法方便有效,值得临床推广.

Objective To summarize the clinical experience of artificial vascular sleeve-like inverted suture in proximal part of ascending aorta, and to explore the effectiveness of the method. Methods A retrospective study was performed. From August 2017 to April 2018, 10 patients with Stanford type A aortic dissection with surgical indications for ascending aortic replacement were treated with artificial vascular sleeve-like inverted suture for proximal part of ascending aorta, 9 cases of emergency operation, 8 cases of males and 2 females, aged 43-69 years, mean(51±6) years old. The specific method for operation is to invert the artificial blood vessel 2 cm outward and then insert it into the ascending aorta, suture the inverted part of the artificial blood vessel and the ascending aorta continuously. If there is obvious bleeding, stitch strips made of artificial blood vessel or pericardium with theanastomosis ring. The drainage in 24 hours after operation and early postoperative outcome were observed. Results There was no intraoperative death in the whole group, and there was no second thoracotomy for hemostasis. The drainage volume was 150-880 ml, average(260±55) ml in 24 hours after surgery. One patient developed gastrointestinal hemorrhage after operation, and healed after two times of hemostasis by bedside gastroscopy. Two patients had transient neurological dysfunction(TND). All of the 10 patients were cured and discharged after treatment. All patients were followed up for 1-6 months. All patients underwent transthoracic echocardiography. Eight of them underwent CT angiography, no new aortic regurgitation, and no obvious sinus widening. Conclusion The artificial blood vessel sleeve-like inverted suture is a simple and reliable operation in reinforcement for proximal part of ascending aorta. The anastomosis circle and the suture pinprick are not directly in contact with the blood flow, reducing the chance of bleeding. Even if there is tinybleeding, it will be easy to find and repair. In conclusion, this method is convenient and effective, and it is worthy of clinical promotion.