125例动脉瘤患者手术后并发症分析

Analyze of postoperative complications for aortic aneurysm in 125 cases

目的 总结 12 5例主动脉瘤及主动夹层瘤患者手术后并发症发尘的原因、种类及并发症的治疗效果。方法 1999年 1月～ 2 0 0 1年 12月 12 5例动脉瘤患者 ,手术方法包括 :保留主动脉瓣人工血管置换 18例 ,复合带瓣人工血管置换 5 3例 ,主动脉根部加主动脉弓替换 13例 ,主动脉根替换加象鼻子手术 6例 ,胸主动脉人工血管置换 16例 ,全胸、腹主动脉人工血管置换 2例 ,腹主动脉瘤成形加自体肾移植 2例 ,腹主动脉人工血管置换 11例 ,胸主动脉腔内支架 4例。结果 全组患者术后出现并发症 2 5例 ,占动脉瘤手术例数的 2 0 % ,并发症包括截瘫 1例占并发症例数的 4 .0 % (1/ 2 5 ) ,一过性意识障碍 5例占 2 0 .0 % (5 / 2 5 ) ,呼吸功能不全 4例占16 .0 % (4 / 2 5 ) ,消化道大出血 2例占 8.0 % (2 / 2 5 ) ,肾功能不全 2例占 8.0 % (2 / 2 5 ) ,严重感染 4例占 16 .0 %(4 / 2 5 ) ,二次开胸止血 6例占 2 4 .0 % (6 / 2 5 ) ,二次升主动脉 -腹主动脉人工血管旁路移植 1例占 4 .0 % (1/2 5 )。死亡 11例 ,死亡率为 8.8% ,死亡例数占并发症例数的 4 4 .0 % (11/ 2 5 )。结论 在动脉瘤手术中术后的并发症以二次开胸止血最高 ,其次为神经系统、呼吸系统、术后感染、肾功能不全和消化道出血等。

Objective: Summarize the cause, denomination and therapeutic efficacy of postoperative complications in 125 cases aortic aneurysm and aorticdissection in recent 3 years.Methods:During 1999.1～2001.12, 125 cases include reserve aortic valve aortic replacement using artificial vessel 18 cases, aortic root replacement using artificial vessel with valve 53 cases, aortic root replacement and aortic arch replacement 13 cases, aortic root replacement and elephant trunk technique 6 cases, thoracic aortic replacement with artificial vessel 16 cases, total thoracic and abdomen aortic replacement with artificial vessel 2 cases, abdomen aortic plastic and arno-kidney transplantation 2 cases, abdomen aortic replacement with artificial vessel 11 cases, thoracic aortic endoluminal stent grafting 4 cases. Method of perfusion includes deep hypothermia circulatory arrest and optional brain low flow perfusion.Results:In all patients, there were twenty-five with complications, mortality rate 8.8%, complications conclude paraplegia 1 cases, transient disturbance of consciousness 5 cases, respiration failure 4 cases, gastric bleeding 2 cases, renal failure 2 cases, severe infection 4 cases, reoperation for bleeding 6 cases, reoperation for ascending aortic-abdomen aortic bypass graft with artificial vessel 1 cases.Conclusions: In aneurysm operation, the highest rate of complications was reoperation for bleeding; the next were nervous system complications, respiratory system complication, postoperative infection, renal malfunction and alimentary tract bleed; The postoperative complications for aortic aneurysm threaten the patients life safety, the mortality rate was 44.0% occupied complications cases. So we should strengthening of management for complication during operation and postoperative.