常温自身动脉转流内脏优先策略在胸腹主动脉置换手术中的脊髓保护作用

Spinal cord protection by normothermic auto-arterial bypass and distal-anastomosis-first strategy in thoracoabdominal aortic replacement surgery

目的 总结常温自身动脉转流内脏优先的胸腹主动脉置换手术策略及其脊髓保护作用,为该策略在胸腹主动脉置换手术中的应用积累临床经验。方法 回顾性分析中国医学科学院阜外医院于2019年6月至2022年6月期间接受常温自身动脉转流内脏优先策略的胸腹主动脉置换手术的患者资料。收集相关临床资料(基线资料、围术期指标、随访结局指标),分析整体治疗效果,以及常温自身动脉转流内脏优先策略的安全性和疗效。结果 共27例胸腹主动脉瘤患者采用常温自身动脉转流内脏优先的方法进行TAAA修复手术治疗。其中Crawford分型Ⅰ型2例(7.4%),Ⅱ型14例(51.9%),Ⅲ型9例(33.3%),Ⅳ型2例(7.4%)。平均手术时间(562.5±99.5)min,术后平均机械通气时间(30.8±25.3) h,术后ICU中位时间112.00(69.00, 162.00)min,术后住院时间(19.8±8.4)d。手术后30 d内死亡1例(3.7%),其他患者均存活。急性肾衰竭3例(11.1%),因出血导致二次开胸手术1例(3.7%)。除死亡患者外,对26例患者进行6~56个月随访,平均随访时间(34.0±11.5)个月。在随访期间未出现截瘫、死亡或其他手术并发症。结论 常温自身动脉转流内脏优先策略可以安全、有效地治疗胸腹主动脉瘤,可以降低脊髓损伤并发症。

Objective To summarize the application of the normothermic artery bypass and visceral-anastomosis-first strategy in thoracoabdominal aortic aneurysm(TAAA)repair and to evaluate its spinal cord protective effect,so as to accumulate clinical experience for the implementation of this procedure in thoracoabdominal aortic replacement surgery.Methods We retrospectively analyzed data of patients who underwent thoracoabdominal aortic replacements with normothermic artery bypass and visceral-anastomosis-first strategy at Fuwai Hospital,Chinese Academy of Medical Sciences,between June 2019 and June 2022.Relevant clinical data(baseline data,perioperative indices,and follow-up outcome indices)were collected to assess the overall treatment outcome,as well as the safety and efficacy of the strategy.Results A total of 27 patients with TAAA were treated surgically for TAAA repair using the normothermic autoarterial diversion with a visceral priority strategy.Among them,2 cases(7.4%)were Crawford classification typeⅠ,14 cases(51.9%)were typeⅡ,9 cases(33.3%)were typeⅢ,and 2 cases(7.4%)were typeⅣ.The mean/median time for surgery,postoperative mechanical ventilation,postoperative ICU time,and postoperative hospital stay were(562.5±99.5)min,(30.8±25.3)h,112.00(69.00,162.00)min,and(19.8±8.4)d,respectively.One case(3.7%)died within 30 days of surgery,and the remaining patients survived.Acute renal failure was observed in 3 cases(11.1%)and re-thoracotomy due to hemorrhage was performed in 1 case(3.7%).Except for the deceased patient,the remaining 26 patients were followed up for a period from 6 to 56 months with a mean follow-up of(34.0±11.5)months.There were no paraplegia,deaths or other surgical complications during the follow-up period.Conclusion The normothermic artery bypass and visceral-anastomosis-first strategy can be safely and effectively used to treat TAAA and may reduce the incidence of spinal cord injury complications.