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[在深低温心肺转流和分段循环停搏下使用四分支血管假体进行一期全胸腹主动脉置换术]

[One-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest].

作者信息

Yu Cun-tao, Sun Li-zhong, Chang Qian, Zhu Jun-ming, Liu Yong-min

机构信息

Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2006 Jan 17;86(3):167-9.

Abstract

OBJECTIVE

To summarize the experience in one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest.

METHODS

From August 2003 to May 2005 38 patients with thoracoabdominal aortic disease, including severe extensive thoracoabdominal aorta of Crawford II type (n = 4), chronic Stanford type B dissecting aneurysm (n = 24), chronic Stanford type A dissecting aneurysm (n = 5), and Marfan's syndrome with chronic Stanford type B dissecting aneurysm (n = 5), 25 males and 13 females, aged 40 +/- 9 (22-58), underwent one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest.

RESULTS

Two patients died during the early post-operational period with a mortality of 5.26%. Four patients showed cerebral complications with an incidence of 10.5% and were cured after hydration therapy. Acute kidney dysfunction occurred in 2 patients and was cured by hemodialysis.

CONCLUSION

With simplified operational procedure, one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermic cardiopulmonary bypass and subsection circulatory arrest significantly shortens the ischemic time of brain, spinal cord, and other major organs and has an excellent effect.

摘要

目的

总结在深低温体外循环及分段循环阻断下应用四分支血管人工血管一期全胸腹主动脉置换术的经验。

方法

2003年8月至2005年5月,38例胸腹主动脉疾病患者,包括重度广泛的CrawfordⅡ型胸腹主动脉瘤(4例)、慢性Stanford B型夹层动脉瘤(24例)、慢性Stanford A型夹层动脉瘤(5例)、Marfan综合征合并慢性Stanford B型夹层动脉瘤(5例),男25例,女13例,年龄40±9(22 - 58)岁,在深低温体外循环及分段循环阻断下应用四分支血管人工血管一期全胸腹主动脉置换术。

结果

术后早期2例患者死亡,死亡率为5.26%。4例患者出现脑部并发症,发生率为10.5%,经补液治疗后治愈。2例患者发生急性肾功能不全,经血液透析治愈。

结论

在深低温体外循环及分段循环阻断下应用四分支血管人工血管一期全胸腹主动脉置换术操作程序简化,显著缩短了脑、脊髓及其他重要器官的缺血时间,效果良好。

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