摘要
目的探讨A型主动脉夹层合并先天性多囊肾的外科治疗效果。方法选取2014年11月至2018年3月首都医科大学附属北京安贞医院收治的11例A型主动脉夹层合并先天性多囊肾患者,其中1例术前主动脉夹层破裂死亡,1例因家属拒绝手术行保守治疗,剩余9例患者均行外科手术治疗。分析手术患者一般资料、手术结果和随访情况。结果 9例手术患者中男6例、女3例,平均年龄(46±10)岁,行主动脉根部替换(Bentall术) 6例、升主动脉替换3例、部分主动脉弓替换1例、全主动脉弓替换+象鼻支架植入术8例、二尖瓣置换1例、三尖瓣成形1例、左颈总动脉-左椎动脉转流1例。患者平均手术时间(480±105) min,体外循环时间(229±32) min,主动脉阻断时间(122±32) min,选择性脑灌注时间(20±11) min。所有患者均成功完成手术,院内死亡1例。术后新发肾功能不全1例,低氧血症2例,新发脑梗死1例。随访率100%,最长随访时间48个月,最短6个月,全组无主动脉相关二次手术,无肾功能衰竭。结论对于合并先天性多囊肾的A型主动脉夹层患者,行低温停循环手术治疗具有良好的近期结果。
Objective To analyze the surgical effect on patients with type A aortic dissection complicated with polycystic kidney.Methods Eleven patients with type A aortic dissection complicated with congenital polycystic kidney were observed in Beijing Anzhen Hospital,Capital Medical University from November 2014 to March 2018.One patient died of rupture of aortic dissection;1 patient had conservative treatment;9 patient received surgery.General data,surgical results and follow-up outcomes were analyzed.Results There were 6 males and 3 females with an average age of(46±10)years.Among the 9 patients,6 patients underwent aortic root replacement(Bentall);3 patients underwent ascending aorta replacement;1 patient underwent partial aortic arch replacement;8 patients underwent total aortic arch replacement plus stent implantation;mitral valve replacement,tricuspid valvuloplasty and left common carotid artery-left vertebral artery bypass were performed in 1 patient respectively.Average operation time was(480±105)min;cardiopulmonary bypass time was(229±32)min;aortic occlusion time was(122±32)min;selective cerebral perfusion time was(20±11)min.All patients completed the operation;1 patient died in hospital.There was 1 case of renal insufficiency,2 cases of hypoxemia and 1 case of cerebral infarction occurring after operation.The follow-up rate was 100%;no secondary aortic surgery and renal failure occurred during 48 months to 6 months of follow-up.Conclusion Surgical treatment with hypothermic circulatory arrest has a good short-term effect on type A aortic dissection with polycystic kidney.
作者
程鹏
葛翼鹏
齐瑞东
钟永亮
乔志钰
里程楠
朱俊明
Cheng Peng;Ge Yipeng;Qi Ruidong;Zhong Yongliang;Qiao Zhiyu;Li Chengnan;Zhu Junming(The 7th Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中国医药》
2019年第5期690-692,共3页
China Medicine
基金
国家科技支撑计划(2015BAI12B03)
北京市科技计划(Z171100001017083)~~
关键词
A型主动脉夹层
多囊肾
外科治疗
Type A aortic dissection
Polycystic kidney
Surgical treatment
