本文選題：主動(dòng)脈弓 + 雜交手術(shù)��； 參考：《臨床心血管病雜志》2017年07期

【摘要】：目的:總結(jié)累及主動(dòng)脈弓的主動(dòng)脈疾病的手術(shù)方法及早期治療效果。方法:對(duì)78例累及主動(dòng)脈弓的主動(dòng)脈疾病患者采用多種手術(shù)方式,觀察其圍手術(shù)期病死率、嚴(yán)重并發(fā)癥發(fā)生率等指標(biāo),并隨訪6個(gè)月,觀察其內(nèi)漏發(fā)生概率和假腔內(nèi)血栓化程度等指標(biāo)。結(jié)果:全組患者圍手術(shù)期共有7例死亡,均為急性Stanford A型主動(dòng)脈夾層,其中6例是全弓置換手術(shù)。18例患者術(shù)后出現(xiàn)各種類型神經(jīng)系統(tǒng)并發(fā)癥。35例患者術(shù)后出現(xiàn)肌酐水平升高,9例患者術(shù)后出現(xiàn)少尿或者無尿,需要進(jìn)行床邊血液透析濾過。22例患者術(shù)后出現(xiàn)急性呼吸窘迫綜合征(ARDS)。6例患者術(shù)后出現(xiàn)應(yīng)激性潰瘍并消化道出血。術(shù)后6個(gè)月復(fù)查時(shí),主動(dòng)脈夾層植入支架的56例患者,除2例術(shù)后出現(xiàn)內(nèi)漏以外,其余患者支架段主動(dòng)脈假腔內(nèi)均形成血栓,其中48例整個(gè)胸降主動(dòng)脈均血栓化。全部存活的主動(dòng)脈夾層患者中,有49例夾層累及腹主動(dòng)脈及其遠(yuǎn)端,6個(gè)月復(fù)查時(shí)僅有9例患者遠(yuǎn)端血管假腔完全血栓化并趨向閉合,其余40例均存在遠(yuǎn)端真假腔共存的情況。結(jié)論:針對(duì)主動(dòng)脈弓部病變的患者,目前有多種手術(shù)方式可供選擇,而每種手術(shù)方式各有優(yōu)勢(shì)與不足。臨床上應(yīng)該根據(jù)患者的病變類型、身體狀況和經(jīng)濟(jì)條件等綜合考慮,選擇合適的治療方案。
[Abstract]:Objective: To summarize the operative methods and early therapeutic effect of aortic arch diseases involving the aortic arch. Methods: 78 cases of aortic arch diseases involving the aortic arch were treated by various surgical methods, the peri operative mortality and the incidence of severe complications were observed and followed up for 6 months to observe the incidence of internal leakage and thrombus in the false cavity. Results: there were 7 deaths in the perioperative period of the whole group, all of which were acute Stanford A type aortic dissection, of which 6 cases were all pantograph replacement surgery,.18 patients had various types of neurological complications after operation,.35 patients had creatinine levels, 9 patients had less urine or no urine after operation, and needed bedside blood. .22 patients with acute respiratory distress syndrome (ARDS) had acute respiratory distress syndrome (ARDS) after operation, and.6 patients suffered from stress ulcers and gastrointestinal bleeding after operation. 6 months after operation, 56 patients with aortic dissection implanted with stent, except 2 cases of internal leakage after operation, were formed in the rest of the stent segments of the aorta, including 48 cases. Of all the survivors of the aortic dissection, 49 of the survivors of the aortic dissection were involved in the abdominal aorta and the distal end of the aortic dissection. In the 6 month reexamination, only 9 cases were completely thrombosed and tended to close. The remaining 40 cases had the coexistence of the distal true and false cavities. Various surgical methods can be selected and each operation has advantages and disadvantages. It should be considered according to the patient's type of disease, physical condition and economic condition, and choose the appropriate treatment.

【作者單位】： 華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬武漢中心醫(yī)院心臟大血管外科;
【基金】：武漢市衛(wèi)計(jì)委重點(diǎn)課題資助(No:WX16A03)
【分類號(hào)】：R654.3

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