本文關(guān)鍵詞： 主動脈弓部瘤 改良術(shù)中支架 改良主動脈弓修復(fù)　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 總結(jié)應(yīng)用改良主動脈弓修復(fù)術(shù)治療主動脈弓部動脈瘤的經(jīng)驗。 材料及方法： 對2009年9月-2015年1月于吉林大學(xué)第二醫(yī)院心血管外科接受手術(shù)治療的主動脈弓部瘤的13例病人進(jìn)行回顧性分析。對患者術(shù)前臨床資料進(jìn)行評估，并通過統(tǒng)計手術(shù)時間、體外循環(huán)時間、升主動脈阻斷時間、停循環(huán)時間、輔助循環(huán)時間情況評估手術(shù)方法；通過記錄患者術(shù)后清醒時間、呼吸機輔助時間、ICU停留時間、術(shù)后在院時間、24小時引流量評估患者術(shù)后恢復(fù)情況，并對所有患者進(jìn)行中期隨訪。 結(jié)果： 13例均為男性患者；年齡分布在29-75歲，平均年齡（59.70±12.86）歲；病因包括真性瘤8例、假性瘤5例，其中2例為外傷性假性動脈瘤；動脈瘤直徑50-80mm；3例為急診手術(shù)：1例為動脈瘤合并急性夾層并破入胸腔，1例為動脈瘤合并急性夾層，1例為動脈瘤破裂破入胸腔，余10例為擇期手術(shù)。所有患者均在全麻、體外循環(huán)下行改良主動脈弓修復(fù)術(shù)。改良主動脈弓修復(fù)術(shù)為使用改良術(shù)中人工血管支架系統(tǒng)，通過主動脈弓橫切口，先行釋放降主動脈人工血管支架，然后根據(jù)術(shù)中探及主動脈弓部動脈瘤累及范圍，從主動脈弓內(nèi)部縫合完成“島狀”主動脈弓置換，無需處理主動脈弓部分支血管即可完成主動脈弓部重建。若術(shù)中探及其他病變，即行相應(yīng)手術(shù)處理。其中：1例患者因無名動脈閉塞行升主動脈-右頸總動脈旁路血管移植術(shù)，1例患者因左、右鎖骨下動脈閉塞行升主動脈-左、右鎖骨下動脈旁路血管移植術(shù)。1例患者為主動脈弓部瘤合并升主動脈瘤、主動脈根部瘤及主動脈瓣重度返流同期行主動脈瓣置換術(shù)、無冠竇成形、升主動脈置換術(shù)。本組患者無術(shù)中死亡，無術(shù)后在院死亡。無患者出現(xiàn)永久性神經(jīng)系統(tǒng)功能損傷，，術(shù)后一過性譫妄1例，急性腎損害1例，出院前均恢復(fù)正常。術(shù)后隨訪13例，隨訪時間為2-70個月。1例術(shù)后3月因氣道狹窄死亡。余12例生存，術(shù)后無支架移位、瘤體復(fù)發(fā)等遠(yuǎn)期并發(fā)癥，術(shù)后恢復(fù)良好，生活質(zhì)量滿意。 結(jié)論： 改良主動脈弓修復(fù)術(shù)避免了傳統(tǒng)主動脈弓置換術(shù)手術(shù)操作難度大及分支血管處理復(fù)雜、手術(shù)時間長、出血大量、并發(fā)癥多、死亡率高的風(fēng)險。采用新型支架人工血管簡化了主動脈弓部的手術(shù)操作，避免了主動脈弓部重建可能引起的災(zāi)難性的出血問題。在治療主動脈弓部動脈瘤方面，改良主動脈弓修復(fù)術(shù)死亡率低，并發(fā)癥發(fā)生率低，遠(yuǎn)期效果好，是一項安全可靠、值得推廣的臨床技術(shù)。
[Abstract]:Objective:. To summarize the experience of modified aortic arch repair in the treatment of aortic arch aneurysms. Materials and methods:. From September 2009 to January 2015, 13 patients with aortic arch tumor undergoing cardiovascular surgery in the second Hospital of Jilin University were retrospectively analyzed. The preoperative clinical data were evaluated and the operative time was counted. Extracorporeal circulation time, ascending aorta occlusion time, circulatory arrest time and auxiliary circulation time were evaluated. Postoperative recovery was evaluated by 24-hour drainage in hospital and all patients were followed up. Results:. 13 cases were all male patients, the age was 29 to 75 years old, the average age was 59.70 鹵12.86 years old, the etiology included 8 cases of true tumor, 5 cases of pseudotumor, 2 cases of traumatic pseudoaneurysm. The diameter of aneurysm 50 to 80 mm in 3 cases was emergency operation: 1 case was aneurysm with acute dissection and 1 case was aneurysm with acute dissection, 1 case was rupture of aneurysm and ruptured thoracic cavity, the remaining 10 cases were elective operation. All the patients were under general anesthesia. The modified aortic arch repair was performed by using the modified aortic arch prosthetic stent system through the aortic arch crosscutting orifice to release the descending aortic prosthetic stent first. Then, according to the extent of the aneurysm involved in the aortic arch, the "island" aortic arch replacement was completed by suturing the aortic arch inside the aortic arch. Reconstruction of the aortic arch can be completed without the need to deal with some branches of the aortic arch. If other lesions are detected during the operation, One patient received ascending aorta-right common carotid artery bypass grafting due to occlusion of the unknown artery, and one patient underwent ascending aorta-left because of left and right subclavian artery occlusion. Right subclavian artery bypass graft was performed in 1 patients with aortic arch aneurysm with ascending aortic aneurysm. Aortic valve replacement was performed simultaneously with aortic root aneurysm and severe aortic regurgitation. There was no intraoperative death, no postoperative death in hospital, no permanent neurological injury, 1 case of transient delirium and 1 case of acute renal damage, all of them recovered to normal before discharge. The follow-up time was 2 to 70 months. 1 cases died of airway stenosis on March. The remaining 12 cases survived without stent displacement and tumor recurrence. The patients recovered well and the quality of life was satisfactory. Conclusion:. The modified aortic arch prosthesis avoids the difficulty of traditional aortic arch replacement and the complicated treatment of branch blood vessels, the operation time is long, the bleeding is large, and the complications are many. The use of new stent prostheses simplifies the operation of the aortic arch and avoids the potentially catastrophic bleeding problems caused by aortic arch reconstruction. In the treatment of aortic arch aneurysms, Modified aortic arch repair is a safe and reliable clinical technique with low mortality, low incidence of complications and good long-term effect.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.3

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本文編號：1555484