目的评估在胸-腹主动脉瘤患者的治疗中双血管缝合器和手术切开2种入路方式的手术安全性和治疗效果。方法 2010年1月至2014年1月在大庆油田总医院住院并且接受介入治疗的患者50例,其中男性27例,女性23例,年龄为37~84岁,平均年龄为(58.21&...目的评估在胸-腹主动脉瘤患者的治疗中双血管缝合器和手术切开2种入路方式的手术安全性和治疗效果。方法 2010年1月至2014年1月在大庆油田总医院住院并且接受介入治疗的患者50例,其中男性27例,女性23例,年龄为37~84岁,平均年龄为(58.21±11.95)岁。根据入路方式分为缝合器组和手术切开组,各25例。比较2组患者非支架置入步骤的手术持续时间,观察止血时间、下床走动的时间和并发症。结果比较手术切开组非支架置入步骤的手术持续时间和缝合器组非支架置入步骤的手术持续时间,(82.0±20.0)min vs(9.0±2.0)min,P<0.001,差异具有统计学意义;2组间下床走动时间比较,3 d vs 4~6 h,P<0.001,差异具有统计学意义;临床随访时间为1个月,均无手术伤口相关并发症发生。结论双血管缝合器在胸-腹主动脉瘤治疗中应用的安全性优于手术切开组,缩短了止血时间和下床走动时间。展开更多
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,...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.展开更多
文摘目的评估在胸-腹主动脉瘤患者的治疗中双血管缝合器和手术切开2种入路方式的手术安全性和治疗效果。方法 2010年1月至2014年1月在大庆油田总医院住院并且接受介入治疗的患者50例,其中男性27例,女性23例,年龄为37~84岁,平均年龄为(58.21±11.95)岁。根据入路方式分为缝合器组和手术切开组,各25例。比较2组患者非支架置入步骤的手术持续时间,观察止血时间、下床走动的时间和并发症。结果比较手术切开组非支架置入步骤的手术持续时间和缝合器组非支架置入步骤的手术持续时间,(82.0±20.0)min vs(9.0±2.0)min,P<0.001,差异具有统计学意义;2组间下床走动时间比较,3 d vs 4~6 h,P<0.001,差异具有统计学意义;临床随访时间为1个月,均无手术伤口相关并发症发生。结论双血管缝合器在胸-腹主动脉瘤治疗中应用的安全性优于手术切开组,缩短了止血时间和下床走动时间。
文摘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.
