改良主动脉弓修复术治疗主动脉弓部动脉瘤

发布时间：2018-03-02 07:04

本文关键词： 主动脉弓部瘤改良术中支架改良主动脉弓修复　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：总结应用改良主动脉弓修复术治疗主动脉弓部动脉瘤的经验。材料及方法：对2009年9月-2015年1月于吉林大学第二医院心血管外科接受手术治疗的主动脉弓部瘤的13例病人进行回顾性分析。对患者术前临床资料进行评估，并通过统计手术时间、体外循环时间、升主动脉阻断时间、停循环时间、辅助循环时间情况评估手术方法；通过记录患者术后清醒时间、呼吸机辅助时间、ICU停留时间、术后在院时间、24小时引流量评估患者术后恢复情况，并对所有患者进行中期随访。结果： 13例均为男性患者；年龄分布在29-75岁，平均年龄（59.70±12.86）岁；病因包括真性瘤8例、假性瘤5例，其中2例为外伤性假性动脉瘤；动脉瘤直径50-80mm；3例为急诊手术：1例为动脉瘤合并急性夹层并破入胸腔，1例为动脉瘤合并急性夹层，1例为动脉瘤破裂破入胸腔，余10例为择期手术。所有患者均在全麻、体外循环下行改良主动脉弓修复术。改良主动脉弓修复术为使用改良术中人工血管支架系统，通过主动脉弓横切口，先行释放降主动脉人工血管支架，然后根据术中探及主动脉弓部动脉瘤累及范围，从主动脉弓内部缝合完成“岛状”主动脉弓置换，无需处理主动脉弓部分支血管即可完成主动脉弓部重建。若术中探及其他病变，即行相应手术处理。其中：1例患者因无名动脉闭塞行升主动脉-右颈总动脉旁路血管移植术，1例患者因左、右锁骨下动脉闭塞行升主动脉-左、右锁骨下动脉旁路血管移植术。1例患者为主动脉弓部瘤合并升主动脉瘤、主动脉根部瘤及主动脉瓣重度返流同期行主动脉瓣置换术、无冠窦成形、升主动脉置换术。本组患者无术中死亡，无术后在院死亡。无患者出现永久性神经系统功能损伤，，术后一过性谵妄1例，急性肾损害1例，出院前均恢复正常。术后随访13例，随访时间为2-70个月。1例术后3月因气道狭窄死亡。余12例生存，术后无支架移位、瘤体复发等远期并发症，术后恢复良好，生活质量满意。结论：改良主动脉弓修复术避免了传统主动脉弓置换术手术操作难度大及分支血管处理复杂、手术时间长、出血大量、并发症多、死亡率高的风险。采用新型支架人工血管简化了主动脉弓部的手术操作，避免了主动脉弓部重建可能引起的灾难性的出血问题。在治疗主动脉弓部动脉瘤方面，改良主动脉弓修复术死亡率低，并发症发生率低，远期效果好，是一项安全可靠、值得推广的临床技术。
[Abstract]:Objective:. To summarize the experience of modified aortic arch repair in the treatment of aortic arch aneurysms. Materials and methods:. From September 2009 to January 2015, 13 patients with aortic arch tumor undergoing cardiovascular surgery in the second Hospital of Jilin University were retrospectively analyzed. The preoperative clinical data were evaluated and the operative time was counted. Extracorporeal circulation time, ascending aorta occlusion time, circulatory arrest time and auxiliary circulation time were evaluated. Postoperative recovery was evaluated by 24-hour drainage in hospital and all patients were followed up. Results:. 13 cases were all male patients, the age was 29 to 75 years old, the average age was 59.70 卤12.86 years old, the etiology included 8 cases of true tumor, 5 cases of pseudotumor, 2 cases of traumatic pseudoaneurysm. The diameter of aneurysm 50 to 80 mm in 3 cases was emergency operation: 1 case was aneurysm with acute dissection and 1 case was aneurysm with acute dissection, 1 case was rupture of aneurysm and ruptured thoracic cavity, the remaining 10 cases were elective operation. All the patients were under general anesthesia. The modified aortic arch repair was performed by using the modified aortic arch prosthetic stent system through the aortic arch crosscutting orifice to release the descending aortic prosthetic stent first. Then, according to the extent of the aneurysm involved in the aortic arch, the "island" aortic arch replacement was completed by suturing the aortic arch inside the aortic arch. Reconstruction of the aortic arch can be completed without the need to deal with some branches of the aortic arch. If other lesions are detected during the operation, One patient received ascending aorta-right common carotid artery bypass grafting due to occlusion of the unknown artery, and one patient underwent ascending aorta-left because of left and right subclavian artery occlusion. Right subclavian artery bypass graft was performed in 1 patients with aortic arch aneurysm with ascending aortic aneurysm. Aortic valve replacement was performed simultaneously with aortic root aneurysm and severe aortic regurgitation. There was no intraoperative death, no postoperative death in hospital, no permanent neurological injury, 1 case of transient delirium and 1 case of acute renal damage, all of them recovered to normal before discharge. The follow-up time was 2 to 70 months. 1 cases died of airway stenosis on March. The remaining 12 cases survived without stent displacement and tumor recurrence. The patients recovered well and the quality of life was satisfactory. Conclusion:. The modified aortic arch prosthesis avoids the difficulty of traditional aortic arch replacement and the complicated treatment of branch blood vessels, the operation time is long, the bleeding is large, and the complications are many. The use of new stent prostheses simplifies the operation of the aortic arch and avoids the potentially catastrophic bleeding problems caused by aortic arch reconstruction. In the treatment of aortic arch aneurysms, Modified aortic arch repair is a safe and reliable clinical technique with low mortality, low incidence of complications and good long-term effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.3

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