主动脉弓部手术75例

目的 总结主动脉弓部手术的方法和临床经验。方法75例弓部手术中74例采用深低温停循环（DHcA）技术，其中54例脑保护采用上腔静脉逆灌（RCP），20例采用右腋动脉顺灌（SCP）；仅1例在中度低温体外循环下行局部切除吻合。升主动脉和半弓置换53例，其中同期行降主动脉腔内支架植入术11例，弓部内膜破口修补6例，降主动脉近端内膜破口修补3例；升主动脉和全弓置换20例，其中同期行传统象鼻手术12例，降主动脉腔内支架植入4例；单纯弓部瘤切除缝合及弓部置换各1例。同期手术包括17例Bentall手术，12例AVR，3例Cabrol手术，5例二尖瓣成形术，9例主动脉瓣悬吊成形术等。DHCA9～120min，平均42．3min。结果手术死亡5例，死亡率6．7％。主要并发症为呼吸功能不全11例，肾功能不全7例，一过性精神异常9例。结论DHCA＋RCP及DHCA＋SCP技术均是主动脉弓部手术的有效方法，但后者更适用于复杂的弓部手术；手术范围和方式取决于病变性质和范围，术前状况和手术技术是影响手术效果的决定因素。

Aortic arch surgery: methods and clinical experience (Report of 75 cases)

Objective To summarize the methods and experiences of aortic arch surgery. Methods In 75 aortic arch operations, 74 were performed by using deep hypothermic circulatory arrest (DHCA), including retrograde cerebral perfusion (RCP) in 54 cases and antegrade selective cerebral perfusion (SCP) in 20 cases. Surgical procedures included ascending aortic and hemiarch grafting in 53 cases, which concomitantly included stent placement intra decending aorta in 11, patching of arch intimal tear in 6 and of decending aortic one in 3. Ascending and total arch grafting in 20 cases,which concomitantly included traditional elephant trunk procedure in 12 and stent placement intra decending aorta in 4. Simple arch aneurysm resection in 1 and arch grafting in 1. Concomitant procedures included Bentall procedure in 17 cases, AVR in 12, Cabrol procedure in 3, mitral valvuloplasty in 5 and aortic valvuloplasty in 9. DHCA time ranged from 9 to 120 min (mean 42.3 min). Results Operative mortality was 6.7%. The most common complications were respiratory insufficiency(11 cases), renal insufficience(7 cases) and temporary mental anomaly(9 cases). Conclusion DHCA+RCP and DHCA+SCP are both effective while the latter is more suitable for complex aortic arch surgery. The choice of surgical procedures depends on the nature of lesion and location of intimal tear. Preoperative condition and surgical technique are the essential factors to success in aortic arch surgery.