胸腹主动脉全程置换术中的肋间动脉血运重建

目的:探讨胸腹主动脉置换术中操作方便快捷的肋间动脉血运重建方法,总结分析行胸腹主动脉全程置换术的患者情况。方法:回顾性分析2001-2010年21例胸腹主动脉全程置换术临床资料。其中男15例,女6例,平均年龄(45±8)岁。手术中对主动脉壁进行修剪,利用主动脉后侧壁缝制肋间动脉共同通道,再以直径8 mm人造血管两端分别与肋间动脉共同通道和胸主动脉人造血管行端侧吻合,重建全部肋间动脉血运供应。结果:2例术后死亡。其余19例未发生脊髓缺血并发症。所有的病人随访6-12个月,未发现肢体运动和感觉缺失症状。CT血管造影(CTA)未提示假性动脉瘤形成,肋间动脉共同通道通畅,肋间动脉共同通道未发生异常扩大。结论:利用主动脉后侧壁,缝制肋间动脉共同通道,重建肋间动脉血运,操作方便快捷,有效减少术中脊髓缺血时间,术后能提供脊髓血液供应。

Revascularization of Intercostal Artery in Thoracoabdominal Aorta Replacement

Objective: To investigate an effective and convenient method of intercostal artery reconstruction during the surgery,we analyzed the clinical data of 21 cases treated by thoracoabodimnal aorta replacement. Methods: From January 2001 to January 2010,total thoracoabdominal aortic replacement was performed in 21 patients.There were 15 male and 6 female patients with a mean age of(45 ± 8) years.We used the posterior wall of aorta to make a common channel of intercostal arteries,and then connected the intercostal artery common channel and the artificial thoracic aorta with an 8 mm artificial vessel through the end-to-side anastomosis to complete the reconstruction of whole intercostal artery blood circulation.Results: Two patients died after surgery,the rest of 19 patients survived and had been followed up for 6-12 months.Spinal cord ischemia complications,such as limb dyskinesia and sensory deficit symptoms were not found in the these patients.CTA did not find the pseudoaneurysm formation,the obstruction and abnormal enlargement of the intercostal artery common channel as well.Conclusion: Using the posterior wall of aorta to make an intercostal artery common channel for reconstruct intercostal artery blood circulation is an effective and convenient method to prevent the complication of spinal cord ischemia.