四分叉人工血管-牛心包预制裙边在A型主动脉夹层手术中应用

Application of Prefabricated Skirt of Four-fork Artificial Vessel and Bovine Pericardium in Stanford Type A Aortic Dissection

目的介绍一种新型主动脉根部右心房分流方法,总结该方法在Stanford A型主动脉夹层手术中的应用效果。方法在31例Stanford A型主动脉夹层患者中,预先使用牛心包胸普外科修补膜(冠昊生物科技股份有限公司,规格型号:B型/TB-S80120)在四分叉人工血管(Maquet公司,规格型号:M00202175728APO)的3个分叉血管根部吻合,人工血管全部吻合完毕之后,将牛心包和残留的升主动脉壁吻合,然后与右心耳吻合在一起,建立与右心房间的交通。结果该方法建立交通容易,吻合方便,需要止血的部位少,止血时间短,31例患者均顺利脱机,无一例术后因为引流液多而需要再次开胸止血。1例患者因脊髓缺血发生双下肢截瘫,经脑脊液引流和激素治疗后,术后3个月下肢肌力1级;1例患者因右侧脑梗死而发生左侧偏瘫,经康复治疗3个月后肌力3级。所有患者术后1个月及6个月复查心脏彩超,均未发现升主动脉根部与右心房间异常血流信号。患者均存活至今。结论该方法应用于Stanford A型主动脉夹层手术患者,具有操作简单、手术时间短、出血少的优势,可避免反复止血和大量输血造成的严重并发症甚至死亡,值得进一步探讨应用。

Objective To introduce a new method of aortic root right atrial shunt,and summarize the application effect of this method in Stanford type A aortic dissection.Methods In 31 patients with Stanford type A aortic dissection,the bovine pericardium(Guanhao Biotechnology Company,B/TB-S80120)was used to anastomose at the root of the three bifurcated blood tubes of the four-fork artificial vessel(Maquet Company,M00202175728APO).After all the artificial vessels were anastomosed,the bovine pericardium was anastomosed with the residual ascending aorta wall,and then was anastomosed with the right atrial appendage,to establish communication with the right atrium.Results This method had the advantages of easy shunt,convenient anastomosis,less bleeding sites and short hemostasis time.Extubation was made smoothly without re-exploration for hemorrhage of anastomosis.One patient suffered from bilateral paraplegia due to ischemia of spinal cord.After cerebrospinal fluid drainage and hormone treatment,the lower limb muscle strength was gradeⅠ.One patient had left hemiplegia due to right cerebral infarction.After 3 months of rehabilitation treatment,the muscle strength was levelⅢ.No patient had abnormal blood flow signals at the root of the ascending aorta and the right atrium at 1-month and 6-month re-examination.All patients survived now.Conclusion For Stanford type A aortic dissection patients,this method has the advantages of simple operation,short operation time and less bleeding,and can avoid serious complications or even death caused by repeated hemostasis and massive blood transfusion.It is worth further discussion and application.