主动脉弓远端病变患者以支架象鼻术联合左锁骨下动脉-左颈总动脉转流术治疗的临床疗效

Clinical effect of stented elephant trunk surgery combined with left subclavian artery-left common carotid artery bypass for patients with distal aortic arch disease

目的探析主动脉弓远端病变患者以支架象鼻术联合左锁骨下动脉-左颈总动脉转流术治疗的临床疗效。方法对郑州市第七人民医院2013年1月至2017年1月收治的30例主动脉弓远端病变患者临床资料进行回顾性分析。30例患者均于我院接受支架象鼻术联合左锁骨下动脉-左颈总动脉转流术治疗。对患者术中与术后情况进行观察,并进行为期10~40个月的随访,了解患者出院后情况。结果 30例患者体外循环时间(145.23±22.84) min。主动脉阻断时间(65.97±19.61) min。选择性脑灌注时间(65.37±25.46) min。在治疗过程中,30例患者均无院内死亡情况发生。患者呼吸机辅助时间为(22.39±4.83) h,ICU观察时间为(44.25±12.21) h。术后,使用呼吸机辅助呼吸超过24 h的患者共有4例,30例患者经过积极治疗后,均已痊愈出院,随访结果显示患者一般情况良好,无内脏缺血与缺血性脊髓损伤等不良情况发生。结论主动脉弓远端病变患者行支架象鼻术联合左锁骨下动脉-左颈总动脉转流术治疗,在手术过程中可对封闭主动脉弓远端病变、主动脉近端病变进行同期处理,确保患者获得预期疗效,降低患者院内病死率,并促进预后的提升。。

【Objective】To explore the clinical efficacy of stented elephant trunk surgery combined with left subclavian artery left common carotid artery bypass for patients with distal aortic arch disease.【Methods】The clinical data of 30 patients with distal aortic arch disease admitted to our hospital from January 2013 to January 2017 were retrospectively analyzed.All 30 patients underwent stented elephant trunk surgery combined with left subclavian artery-left common carotid artery bypass in our hospital.The patient's intraoperative and postoperative conditions were observed,and a 10-to 40-month follow-up was conducted to understand the patient's condition after discharge.【Results】The cardiopulmonary bypass time of 30 patients was 145.23±22.84 min.The aortic occlusion time was 65.97±19.61 min.Selective brain perfusion time was 65.37±25.46 min.During the course of treatment,no hospital deaths occurred in the 30 patients.The patient's ventilator assistance time was 22.39±4.83 h,and the time spent in ICU was 44.25±12.21 h.After the operation,there were 4 patients who used ventilator to assist breathing for more than 24 hours.After active treatment,all 30 patients were cured and discharged.The follow-up results showed that the patients were generally in good condition,without visceral ischemia and ischemic spinal cord injury.【Conclusion】When patients with distal aortic arch lesions were treated with stented elephant trunk surgery combined with left subclavian artery-left common carotid artery bypass,the closed aortic arch distal lesions and proximal aortic lesions can be treated at the same time to ensure expected curative effect and reduce the risk of death.