摘要
目的 总结胸腹主动脉瘤 (TAA)分次主动脉阻断法胸腹主动脉重建的经验 ,探讨该手术方式对降低手术病死率、减少严重并发症———肾衰、截瘫等的作用。 方法 运用改良的Crawford法行胸腹主动脉分支重建术 13例。其中男性 9例 ,女性 4例。TAA分型为Ⅰ型 1例 ,Ⅱ型 1例 ,Ⅲ型2例 ,IV型 3例 (Crawford分型 ) ;主动脉夹层DebakeyⅠ型 1例 ,主动脉夹层DebakeyⅢ型 4例 (其中 2例为动脉瘤破裂急诊手术病例 ) ;主动脉缩窄 1例。 结果 13例手术均成功完成 ,1例于手术即将结束时因心脏意外死亡 ,手术病死率为 7 7% (1/ 13)。本组病例手术并发症 :急性坏死性胰腺炎 1例 ,ARDS 1例 ,胸腔出血 2例 ,截瘫、急性肾功能衰竭发生率各为 7 7%。 结论 分次主动脉阻断法行胸腹主动脉重建术降低了手术病死率及凶险并发症发生率 ,减少了脏器的缺血性损伤 ,是常温全身麻醉下行主动脉置换较为合理的方式。
Objective Fractionated clamping was applied to aneurysm repair in patients with thoracoabdominal aortic aneurysm(TAA), and its effects in decreasing operative mortality and severe complications such as renal failure and hemiplegia were discussed. Methods Using improved shunting and cross clamping technique, we repaired 13 thoracoabdominal aortae and their branches (9 males and 4 females). TAA Crawford type: type Ⅰ one case, type Ⅱ two cases, type Ⅲ two cases and type IV three cases. TAA dissection Debakey type: type Ⅰ one cose, type Ⅲ four cases (including 2 of ruptured aneurysm) and aorta stenosis one case. Results Twelve procedures were performed successfully. One patient died of cardiac attack immediately before accomplishment of the operation with a operative mortality rate of 7 7%(1/13). Operative complications included acute necrotizing pancreatitis (1 case), ARDS (1), thoracic cavity bleeding (2), hemiplegia (1), and acute renal failure (1). The incidence rate of complications was significantly lower than that reported elsewhere. Conclusions Fractionated clamping for thoracoabdominal aortic aneurysm repair is a renovation on the basis of Crawford procedure and aorta bypass method. Clinical results demonstrated that the procedure decreases the surgical mortality and the incidence rate of dangerous complications. Fractionated clamping for aorta replacement is a reasonable procedure under general anesthesia at normal temperature.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2001年第11期825-828,共4页
Chinese Journal of Surgery
