Perclose缝合器在A型主动脉夹层手术中的应用效果

Efficacy of using Perclose ProGlide closure device in type A aortic dissection surgery

目的评估在Stanford A型主动脉夹层手术中使用Perclose缝合器的效果。方法选取2011年5月至2021年5月我院21例A型主动脉夹层动脉瘤患者行主动脉置换术时经股动脉插管建立体外循环,其中常规切开股动脉直视下插管11例,为对照组;经皮穿刺股动脉插管并采用Abbott Perclose Proglide经皮血管缝合器修复股动脉10例,为实验组。回顾分析两组患者的股动脉操作时间、下肢制动时间、术后ICU停留时间及并发症发生率。结果两组患者股动脉操作时间[(5.15±3.38)min比(20.33±10.67)min,P<0.01]和术后下肢制动时间[(2.13±1.28)h比(8.23±4.77)h,P<0.05]经皮穿刺组明显低于直视切开组,差异有统计学意义。手术相关并发症及ICU停留时间差异无统计学意义[10.0%比18.2%,P=0.13;(49.23±10.35)h比(50.33±12.31)h,P=0.52]。结论 A型主动脉夹层手术时Perclose缝合器的使用可避免传统开放直视下股动脉插管并做股动脉缝合修补的缺陷,是一种安全、快速的应用方式。

Objective To investigate the effect of Perclose Pro Glide closure devicein Stanford type A aortic dissection surgery. Methods From May 2011 to May 2021, a total of 21 patients with Stanford A type aortic dissection were treated with ascending aorta replacement in our hospital. Extracorporeal circulation was established via femoral artery cannulation in all patients. Routine femoral artery incision and direct intubation were performed in 11 cases, and percutaneous femoral artery cannulation and repair of femoral artery by Abbott Perclose Proglide percutaneous vascular suture device were performed in 10 cases. The femoral artery operation time, lower limb immobilization time, postoperative ICU time and incidence of the complications in 2 groups were analyzed. Results The procedure duration [(5.15 ± 3.38) min vs.(20.33 ± 10.67) min, P<0.01] and lower limb immobilization time [(2.13±1.28) h vs.(8.23±4.77) h, P<0.05] were shorter in the percutaneous access group. A composite of procedure-related complications and postoperative ICU time was not significantly different between groups [10.0% vs. 18.2%, P=0.13 and(49.23±10.35) h vs.(50.33±12.31) h, P=0.52]. Conclusions The use of Perclose Pro Glide closure device in type A aortic dissection can avoid the defects of femoral artery cannulation under direct vision. It is an safe and minimally invasive method.