两种新型改良主动脉弓部手术的初步探索

Preliminary exploration of two new improved aortic arch surgery

目的:探讨主动脉弓部手术的两种新型改良方式:采用左锁骨下动脉插管灌注结合改良弓部岛状吻合方式及改良的弓部优先手术方式初步,为涉及主动脉弓部的手术提供更优的临床方案。方法:回顾性分析2019年12月至2022年9月期间,徐州医科大学附属医院心脏大血管外科13例涉及弓部手术行孙氏手术的患者,7例采用左锁骨下插管灌注结合岛状吻合的手术方式,6例患者采取弓部优先的手术方式。结果:左锁骨下优先手术组对比弓部优先手术组:体外循环时间:(241.6±27.8)vs.(156.0±45.5) min,主动脉阻断时间:(166.6±20.3)vs.(89.7±33.0)min,术后ICU住院时长:(13.3±3.0)vs.(3.8±1.9)d。所有病例无透析,无二次开胸止血,均痊愈出院。随访18(11~24)个月,无再次手术干预,无死亡病例。结论:两种新型改良主动脉弓部手术方式均安全有效,其中弓部优先手术方式能够进一步缩短体外循环和主动脉阻断时间,并缩短患者术后监护室停留时间。

Objective:To explore a better clinical plan for aortic arch surgery by comparing two new improvements involving aortic arch surgery:left subclavian artery infusion combined with improved arch island anastomosis and improved arch priority surgery.Methods:From December 2019 to September 2022,13 patients in the Department of Cardiovascular Surgery,Affiliated Hospital of Xuzhou Medical University were retrospectively treated with Sun Shi surgery,7 patients were treated with left subclavian intubation perfusion combined with island anastomosis,and 6 patients were treated with arch priority surgery.Results:In the left subclavian priority group,compared with the arch priority group,the time of cardiopulmonary bypass was(241.6±27.8)vs.(156.0±45.5)min the time of aortic occlusion was(166.6±20.3)vs.(89.7±33.0)min,the length of stay in ICU was(13.3±3.0)vs.(3.8±1.9)d.18 months(range 11-24 months),no reoperation intervention and no death.Conclusions:Two new modified aortic arch surgery are safe and effective.Arch priority surgery can further shorten the time of cardiopulmonary bypass and aortic occlusion and shorten the stay time of patients in intensive care unit after operation.