摘要
OBJECTIVE: To apply fractionated-clamping for repair of thoracoabdominal aortic aneurysm (TAA), and evaluate its effects in decreasing surgical mortality and severe complications, such as renal failure and paraplegia, a modified crawford procedure were prospectively evaluated. METHODS: Using modified shunting and cross-clamping techniques, modified Crawford repair in 13 thoracoabdominal aorta patients were performed in the Vascular Division at Peking Union Medical College Hospital. TAA Crawford classification: 1 type I, 2 type II, 2 type III and 3 type IV TAA. Debakey classification: 1 type I, 4 type III (including 2 ruptured aneurysms), and 1 aortic coarctation. RESULTS: Thirteen procedures were performed successfully. One died of ventricular fibrillation just before completing the operation. Surgical mortality rate was 7.7% (1/13). Postoperative complications included 1 acute necrotic pancreatitis, 1 ARDS, 1 paraplegia, 1 acute renal failure, and 2 thoracic cavity bleeding. Total complication rate was 53.8% (7/13). CONCLUSIONS: Fractionated-clamping in thoracoabdominal aortic aneurysm repair is our modified Crawford procedure and aortic bypass. Clinical results demonstrate that our procedure decreased surgical mortality and major complication rate, and also alleviated viscera ischemic injury. Fractionated-clamping in aorta replacement is a practical procedure for TAA repair under general anesthesia at normal temperature.
目的 总结胸腹主动脉瘤 (TAA)分次主动脉阻断法胸腹主动脉重建的经验 ,探讨该手术方式对降低手术死亡率、减少严重并发症肾衰、截瘫等的作用。方法 自 1993年以来 ,我科运用改良的Crawford法行胸腹主动脉及其分支重建 13例。男性 9例 ,女性 4例。TAA分型为Ⅰ型 1例 ,Ⅱ型 1例 ,Ⅲ型 2例 ,Ⅳ型 3例 (Crawford分型 ) ,主动脉夹层DebakeyⅠ型 1例 ,Ⅲ型 4例 (其中 2例为动脉瘤破裂急诊手术病例 ) ,主动脉缩窄 1例。结果 13例手术均成功完成 ,1例于手术即将结束时因为心脏意外导致死亡 ,手术死亡率为 7 7% (1/13)。本组病例手术并发症 :急性坏死性胰腺炎 1例 ,ARDS1例 ,胸腔出血 2例 ,截瘫、急性肾衰发生率各为 7 7% ,明显低于文献报道。结论 分次主动脉阻断法行胸腹主动脉重建术是我院血管外科在Crawford法以及转流术基础上改进设计的方法 ,临床效果显示该手术方法降低了手术死亡率以及凶险并发症发生率 ,减少了脏器的缺血性损伤 。
