Suzuki Tomoaki, Asai Tohru, Matsubayashi Keiji, Kambara Atsushi, Kinoshita Takeshi, Hiramatsu Norihiko, Nishimura Osamu
Department of Cardiovascular Surgery, Shiga University of Medical Science, Setatsukinowa, Ootsu, Shiga 520-2192, Japan.
Interact Cardiovasc Thorac Surg. 2010 Jul;11(1):34-7. doi: 10.1510/icvts.2009.231852. Epub 2010 Apr 12.
The femoral and axillary arteries are common arterial cannulation sites for repair of type A dissection. However, these peripheral approaches involve certain problems. From January 2002 to August 2009, a total of 77 patients underwent emergency surgery for acute type A dissection. Central cannulation was applied in 26 patients and peripheral cannulation in 51. The arterial cannulation site was decided according to preoperative computed tomography findings, the patient's condition, and intraoperative epiaortic ultrasonography findings. Central cannulation was avoided in cases of cardiac tamponade with shock. A cannula was inserted under ultrasound guidance using the Seldinger technique. Preoperative patient comorbidities and dissection-related complications were equally distributed between the two groups. Central cannulation was successfully performed in all 26 cases without incident. Operation time, cardiopulmonary bypass time, mean intubation time and mean intensive care unit stay duration were significant shorter in the central group. One patient (4%) died in the central group compared with four patients (8%) in the peripheral group (P=0.45). Direct central cannulation was successful for repair of type A dissection in selected patients and produced equal or superior surgical data to peripheral cannulation, thus providing one option in the approach to this condition.
股动脉和腋动脉是A型主动脉夹层修复术中常用的动脉插管部位。然而，这些外周途径存在一定问题。2002年1月至2009年8月，共有77例患者接受了急性A型主动脉夹层急诊手术。26例采用中心插管，51例采用外周插管。根据术前计算机断层扫描结果、患者病情及术中主动脉外膜超声检查结果确定动脉插管部位。伴有休克的心包填塞患者避免中心插管。采用Seldinger技术在超声引导下插入插管。术前患者合并症和与夹层相关的并发症在两组间分布均衡。26例均成功进行中心插管，无不良事件发生。中心组的手术时间、体外循环时间、平均插管时间和平均重症监护病房停留时间明显更短。中心组1例患者（4%）死亡，外周组4例患者（8%）死亡（P=0.45）。对于部分患者，直接中心插管成功用于A型主动脉夹层修复，手术数据与外周插管相当或更优，因此为该病的治疗提供了一种选择。
