应用升主动脉-腹主动脉搭桥术治疗复杂主动脉缩窄

目的:探讨手术治疗复杂主动脉缩窄的简便、安全、有效的方法。方法:在全麻和常温下经胸腹正中联合切口行升主动脉-腹主动脉搭桥术。结果:手术治疗3例患者,上肢血压下降明显,下肢血压升高满意,无神经系统和其他严重并发症。结论:该手术显露和操作简单,适应证广,疗效确切,并发症少。

腹主动脉搭桥、硬膜外导管内撑法建立大鼠肾移植模型

目的 建立简便、成功率高的大鼠肾移植模型。方法 SD大鼠为供受体 ,采用自行设计的供体腹主动脉搭桥、硬膜外导管内撑法重建动脉血供。供体后腔静脉袖套套入受体左肾静脉重建静脉回流。供体膀胱瓣与受体膀胱全层缝合。结果 整个移植过程 160min ,热缺血时间 <5s ,冷缺血时间 <80min ,血管吻合时间 40min。 41例手术中 ,3 5例成功 ,手术成功率 85 .4%。术后淋巴漏 2例 ,尿漏 1例 ,输尿管入膀胱处狭窄 1例 ,术后并发症发生率 11.4%。结论 本模型具有操作相对简单、对手术器械和术者的手术技能要求低、成功率高、并发症少等优点 。

成人型复杂主动脉缩窄的外科治疗

目的探讨成人型复杂主动脉缩窄的外科治疗方法及临床效果。方法回顾性分析2005年12月至2012年7月间经非体外循环下行升主动脉一腹主动脉搭桥手术治疗的6例成人型复杂主动脉缩窄患者的临床资料。结果本组无围术期死亡病例，术后患者症状明显好转，下肢血压升高，上下肢收缩压差〈10mmHg（1mmIHg=0．133kPa），出院随访5～9个月，6例患者血压均恢复正常，复查CT血管造影显示人工血管血流通畅，未出现主动脉再狭窄、假性动脉瘤等并发症。结论非体外循环下经正中胸腹联合切口升主动脉一腹主动脉搭桥手术治疗成人型复杂主动脉缩窄疗效确切，手术操作虽略显复杂，但安全度较高，适于临床选择应用。

Thoraco-abdominal Aorta Revascularization through a Retroperitoneal Approach

Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.