球囊封堵联合全弓置换及支架象鼻手术治疗主动脉弓部病变——单中心100例早期临床结果分析

Balloon occlusion technique combined with total arch replacement and frozen elephant trunk in the treatment of complex aortic arch diseases:an early clinical analysis of 100 cases in a single center

目的评价球囊封堵技术联合全弓置换及支架象鼻手术治疗主动脉弓部病变的安全性和有效性。方法回顾性分析阜外医院2017年8月至2018年9月100例行球囊封堵技术联合全弓置换及支架象鼻手术患者的临床资料,分析其早期临床结果。结果本组患者停循环时间(5.2±3.1)min,最低鼻咽温(27.9±1.0)℃,最低尿温(29.2±1.2)℃。院内死亡1例,原因为急性肝衰竭引起的多器官功能衰竭,30天死亡共4例。其他术后并发症包括脑梗塞3例,截瘫2例,需IABP辅助的低心排血量综合征1例,需持续透析的肾衰竭5例,二次开胸止血4例,二次气管插管3例,喉返神经损伤1例,骨筋膜室综合征1例。结论球囊封堵技术联合全弓置换及支架象鼻手术应用于复杂主动脉弓部病变中安全可靠,其器官保护作用仍需大样本对比研究证实。

Objective To evaluate the safety and efficacy of balloon occlusion technique combined with total arch replacement and frozen elephant trunk in the treatment of complex aortic arch diseases.Methods The clinical data of 100 patients undergoing balloon occlusion technique combined with total arch replacement and frozen elephant trunk surgery in Fuwai Hospital from August 2017 to September 2018 were retrospectively reviewed,and the early clinical results were analyzed.Results The average circulatory arrest time was(5.2±3.1)min.The lowest nasopharyngeal and bladder temperature was(27.9±1.0)℃and(29.2±1.2)℃,respectively.One patient died in hospital due to multiple organ failure caused by acute liver failure,and a total of 4 patients died within 30 days.Other postoperative complications included cerebral infarction in 3 cases,paraplegia in 2 cases,low cardiac output syndrome requiring IABP assistance in 1 case,renal failure requiring continuous dialysis in 5 cases,redo for bleeding in 4 cases,reintubation in 3 cases,recurrent laryngeal nerve injury in 1 case,and osteofascial compartment syndrome in 1 case.Conclusion Balloon occlusion technique combined with total arch replacement and frozen elephant trunk is safe and feasible in the treatment of complex aortic arch diseases.Its organ protection effect still needs to be confirmed by large sample comparison study.