主动脉术式中国专家共识——胸腹主动脉置换术

Chinese expert consensus on aortic surgery——consensus on total thoracoabdominal aortic replacement

当主动脉壁结构破损、管壁变薄,在管腔内高压血流冲击下,局部向外膨胀扩张并达到正常主动脉直径的1.5倍以上时定义为主动脉瘤。胸腹主动脉瘤指从左锁骨下动脉以远至髂动脉分叉之间的主动脉瘤。由于胸腹主动脉瘤累及范围广,涉及几乎全身所有内脏器官,手术无法避免会导致器官缺血,且手术切口、手术范围毗邻关系复杂,手术时间长,术后全身系统均可能出现并发症,全胸腹主动脉置换术一直是主动脉外科中的难点。近年来手术推广、麻醉管理、体外循环技术、术后监护水平、抗凝血药物甚至人工材料的改进,显著提高了全胸腹主动脉置换术的安全性。本共识详细描述技术难点,包括胸降主动脉及腹主动脉的显露、腹腔脏器血管重建等细节。

Aortic aneurysms are usually defined as local dilation that reaches more than 1.5 times the normal diameter of the normal aorta.Thoracoabdominal aortic aneurysm refers to the extending from the left subclavian artery to the bifurcation of the iliac artery.Since it involves almost all the visceral organs of the whole body,the total thoracoabdominal aortic replacement has always been one of the most difficult and highest mortality and morbidity in cardiac surgery.Due to the unremitting efforts of experts in the past two decades,the safety of the operation has been improved significantly.Based on summarizing the previous experience,this paper describes the operation details in detail,to impart experience and point out the direction for the majority of young doctors.