78例累及主动脉弓的主动脉疾病患者弓部处理方式及早期随访结果

发布时间：2018-05-14 23:13

本文选题：主动脉弓 + 杂交手术　；参考：《临床心血管病杂志》2017年07期

【摘要】：目的:总结累及主动脉弓的主动脉疾病的手术方法及早期治疗效果。方法:对78例累及主动脉弓的主动脉疾病患者采用多种手术方式,观察其围手术期病死率、严重并发症发生率等指标,并随访6个月,观察其内漏发生概率和假腔内血栓化程度等指标。结果:全组患者围手术期共有7例死亡,均为急性Stanford A型主动脉夹层,其中6例是全弓置换手术。18例患者术后出现各种类型神经系统并发症。35例患者术后出现肌酐水平升高,9例患者术后出现少尿或者无尿,需要进行床边血液透析滤过。22例患者术后出现急性呼吸窘迫综合征(ARDS)。6例患者术后出现应激性溃疡并消化道出血。术后6个月复查时,主动脉夹层植入支架的56例患者,除2例术后出现内漏以外,其余患者支架段主动脉假腔内均形成血栓,其中48例整个胸降主动脉均血栓化。全部存活的主动脉夹层患者中,有49例夹层累及腹主动脉及其远端,6个月复查时仅有9例患者远端血管假腔完全血栓化并趋向闭合,其余40例均存在远端真假腔共存的情况。结论:针对主动脉弓部病变的患者,目前有多种手术方式可供选择,而每种手术方式各有优势与不足。临床上应该根据患者的病变类型、身体状况和经济条件等综合考虑,选择合适的治疗方案。
[Abstract]:Objective: To summarize the operative methods and early therapeutic effect of aortic arch diseases involving the aortic arch. Methods: 78 cases of aortic arch diseases involving the aortic arch were treated by various surgical methods, the peri operative mortality and the incidence of severe complications were observed and followed up for 6 months to observe the incidence of internal leakage and thrombus in the false cavity. Results: there were 7 deaths in the perioperative period of the whole group, all of which were acute Stanford A type aortic dissection, of which 6 cases were all pantograph replacement surgery,.18 patients had various types of neurological complications after operation,.35 patients had creatinine levels, 9 patients had less urine or no urine after operation, and needed bedside blood. .22 patients with acute respiratory distress syndrome (ARDS) had acute respiratory distress syndrome (ARDS) after operation, and.6 patients suffered from stress ulcers and gastrointestinal bleeding after operation. 6 months after operation, 56 patients with aortic dissection implanted with stent, except 2 cases of internal leakage after operation, were formed in the rest of the stent segments of the aorta, including 48 cases. Of all the survivors of the aortic dissection, 49 of the survivors of the aortic dissection were involved in the abdominal aorta and the distal end of the aortic dissection. In the 6 month reexamination, only 9 cases were completely thrombosed and tended to close. The remaining 40 cases had the coexistence of the distal true and false cavities. Various surgical methods can be selected and each operation has advantages and disadvantages. It should be considered according to the patient's type of disease, physical condition and economic condition, and choose the appropriate treatment.

【作者单位】：华中科技大学同济医学院附属武汉中心医院心脏大血管外科;
【基金】：武汉市卫计委重点课题资助(No:WX16A03)
【分类号】：R654.3

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