杂交手术室行Stanford B型主动脉夹层腔内修复术122例护理配合

目的:探讨杂交手术室行Stanford B型主动脉夹层腔内修复术患者的护理配合方法。方法:对122例杂交手术室行Stanford B型主动脉夹层腔内修复术患者给予精心围术期护理配合。结果:本组手术均顺利完成,术后CTA随访证实所有病例夹层破口完全封闭,假腔内血栓形成。结论:利用杂交手术室的优势,配备高素质专业护理人员,做好术前、术中护理配合是手术成功的重要保证。     

腹主动脉瘤腔内隔绝术的配合

自 1996年率先在国内开展腔内隔绝术 (ＥＶＧ)治疗腹主动脉瘤患者 13例 ,取得满意的疗效。其护理配合重点是 :(1)做好充分的术前准备 ;(2 )术中密切观察患者双下肢末梢血运情况、出血量及尿量。 (3)手术室护士必须掌握ＥＶＧ的配合技能 ,在操作过程中除了保持其无菌性外 ,还应注意保护避免损伤。 (4)加强对手术环境的监控。腹主动脉瘤腔内隔绝术的配合$第二军医大学长海医院手术室!上海200433@王蔚     

“一站式”杂交手术方法治疗胸主动脉瘤及夹层动脉瘤的介入护理

目的探讨“一站式”杂交手术治疗胸主动脉瘤及夹层动脉瘤的术中护理配合的经验及管理。方法对10例胸主动脉瘤和夹层动脉瘤患者,在导管室行杂交手术,术中护士与医生的默契配合,严密生命体征监护,充分的各种抢救药品、器械的准备,保证手术顺利进行,防止各种并发症的发生。结果通过介入护理,患者均成功顺利完成杂交手术,术中无并发症发生。结论严格的护理管理,介入专科护士技能的培训,对杂交手术治疗胸主动脉瘤和夹层动脉瘤患者护理是安全有效的,术中介入护士与医生的默契、熟练配合,严密的生命体征监护对保证手术成功有重要作用。     

腹主动脉瘤合并高血压患者介入室内行腔内隔绝术的围手术期护理

目的探讨腹主动脉瘤腔内修复术的围手术期护理要点。方法对8例腹主动脉瘤合并高血压的患者于术前做好入院指导及心理护理,调整其心理状态以适应手术,防止腹主动脉瘤破裂;术中注意麻醉前及气管插管时血流动力学的剧烈波动,调控及密切观察血压的变化,防治心律失常;术后做好各种管道的护理观察,密切各种并发症的观察及护理。结果8例腹主动脉瘤合并高血压患者移植物全部成功置入,术后黑便1例,发热1例,经及时治疗与护理病情恢复良好,未出现肾功能衰竭及下肢血栓形成。患者均在术后2周内康复出院。结论腹主动脉瘤腔内修复治疗系微创手术,但患者多合并一定的并发症,且手术本身亦有一定的并发症,加强围手术期护理,预防并及时处理并发症是提高手术成功率,保障患者痊愈的重要环节。     

复杂先心“一站式”杂交手术的护理配合

目的：探讨“一站式”杂交手术治疗复杂先心的术中护理配合的经验及管理。方法：15例复杂先心的患者接受了“一站式”杂交手术,术前各方面准备充分,术中与医生配合默契。结果：所有手术过程顺利,术后均康复出院。结论：“一站式”杂交手术室护理人员知识技术技能全面、与术者配合默契以及先进的管理理念是手术成功的重要保障,随着手术量增加,护理配合将日臻完善。     

腹主动脉瘤合并高血压患者介入室内行腔内隔绝术的围手术期护理

目的 探讨腹主动脉瘤腔内修复术的围手术期护理要点。方法 对8例腹主动脉瘤合并高血压的患者于术前做好人院指导及心理护理，调整其心理状态以适应手术，防止腹主动脉瘤破裂；术中注意麻醉前及气管插管时血流动力学的剧烈波动，调控及密切观察血压的变化，防治心律失常；术后做好各种管道的护理观察，密切各种并发症的观察及护理。结果 8例腹主动脉瘤合并高血压患者移植物全部成功置入，术后黑便1例，发热1例，经及时治疗与护理病情恢复良好，未出现肾功能衰竭及下肢血栓形成。患者均在术后2周内康复出院。结论 腹主动脉瘤腔内修复治疗系微创手术，但患者多合并一定的并发症，且手术本身亦有一定的并发症，加强围手术期护理，预防并及时处理并发症是提高手术成功率，保障患者痊愈的重要环节。     

腹主动脉瘤腔内修复术操作技巧及并发症防治策略

随着腔内治疗技术发展,腹主动脉瘤腔内修复术已发展成为腹主动脉瘤治疗的重要方法,其微创性、安全性和有效性逐渐得到了广泛认可。同传统外科技术一样,血管外科医师应该深刻理解和全面了解腔内修复术的手术适应证和禁忌证、操作要领及其并发症防治对策。本文将总结和讨论腹主动脉瘤腔内修复术的术前准备和术中操作的关键技术、注意事项,同时重点讨论腹主动脉瘤腔内修复术的并发症及其防治对策。     

“一站式杂交”手术高值耗材库在血管外科的运行与管理

目的探讨"一站式"杂交手术高值耗材库在血管外科运行和管理模式。方法 2009年3月至2010年9月对解放军总医院高值耗材库各种品牌、不同规格的导管、导丝、球囊、支架等,根据日常手术量设定基本库存量,备齐每日手术所需的各种导管耗材,严格做好耗材的入库、出库登记;术前与术中准确核对所需导管耗材的种类、型号、规格等,保证手术顺利进行;同时每日清点高值医用耗材的使用量并及时补充库存量。结果 2009年3月至2010年9月,杂交手术室共完成腹主动脉瘤腔内修复术100例、主动脉腔内修复术84例、颈动脉狭窄46例、下肢动脉栓塞切开取栓65例、下肢静脉切开取栓5例,其他外周血管介入治疗手术700余例,所有杂交手术均未出现导管耗材的缺货和支架错误植入的现象。结论严格执行杂交手术高值医用耗材库的系统化管理,是确保血管外科杂交手术顺利进行及避免医疗差错事故发生的有效措施。     

感染性腹主动脉瘤的外科治疗

目的探讨感染性腹主动脉瘤的外科手术治疗策略选择。方法回顾性分析2001年7月至2008年12月解放军总医院血管外科收治并手术的9例感染性腹主动脉瘤病例,其中肾下腹主动脉瘤8例,单纯髂总动脉瘤1例。3例采用外科手术,3例采用腔内修复术,3例采用一期或分期杂交手术。结果外科手术组1例患者术后发生多器官功能衰竭于术后6d死亡,1例术后发生切口感染裂开而二次手术缝合,腔内修复组和杂交手术组无围手术期死亡及手术并发症。随访时间为6～77个月,中位数36个月。外科手术组术后2年生存率为33.3%(1/3),腔内治疗组2年生存率为66.7%(2/3),杂交手术组2年生存率为66.7%(2/3)。人工血管移植物2年通畅率57.1%(4/7)。结论腔内修复术治疗感染性腹主动脉瘤是安全有效的,尤其适用于高危患者,但术后需要密切随访,如发现感染病灶持续存在或瘤体增长,则需要考虑外科手术。     

46例腹主动脉瘤手术的护理配合及体会

总结了46例腹主动脉瘤手术的护理配合及体会,分别从术前配合和术中配合2个方面进行了阐述。认为手术室护士术前充分准备、术中熟练配合是手术成功的重要条件。     

血管外科“一站式杂交”手术的护理管理

目的探讨血管外科＂一站式杂交＂手术的护理管理。方法回顾分析2009年3-12月在＂一站式杂交＂手术室完成的462例杂交手术的临床资料,总结护理管理经验。结果所有患者手术过程中的护理工作、安全管理均有条不紊,未出现任何危及患者安全的情况,手术均顺利进行。结论护理人力资源的合理配置、规范化的护理管理、准确的手术配合是＂一站式杂交＂手术成功的有力保障。     

Advances in the endovascular management of acute injury

Traumatic vascular injuries are common in the multi-injured patient. Exposure and repair can often be challenging, particularly in the pelvis, chest, and distal carotid arteries. The explosion of endovascular technology over the last decade has brought innovative strategies to managing vascular trauma in the injured patient.( 1 ) Hybrid operating rooms provide the perfect opportunity to perform arteriography, minimally invasive proximal control, and therapeutic intervention, be it endovascular, open, or a hybrid combination thereof. In the absence of a hybrid operating room, an angiographic table and portable C-arm in the operating room is certainly acceptable. Percutaneous and hybrid techniques to manage nonaortic arterial trauma will be reviewed.     

Hybrid aortic arch and frozen elephant trunk reconstruction: bridging the gap between conventional and total endovascular arch repair

Introduction: Novel endovascular techniques hope to offer patients aortic arch repair with reduced morbidity compared to conventional arch surgery; however, current endovascular strategies remain challenged by the proximal seal zone, higher stroke rates, long-term durability and select anatomy. Hybrid arch repair offers patients a less invasive alternative that can treat more distal aorta than conventional arch repair yet still be performed via standard sternotomy.

Areas covered: This review will discuss the current evidence and future development of hybrid aortic arch and frozen elephant trunk reconstruction. Several approaches to hybrid arch repair are summarized, including the off-label use of thoracic endovascular stent-grafts and commercially manufactured hybrid grafts. Technical considerations and clinical outcomes with each approach will be addressed along with advantages and disadvantages.

Expert commentary: Hybrid arch repair will undergo continued refinement as our ability to provide a less-invasive alternative to conventional open arch repair grows. Evolution to allow for improved head vessel branch sizing, improved frozen elephant trunk deployment accuracy, monitoring to prevent paraplegia and utilization of intraoperative image guidance in hybrid operating rooms is necessary. The potential exists for hybrid approaches to arch pathology to completely supplant conventional surgery, while avoiding the potential deleterious complications of total endovascular repair.     

One-stop hybrid surgery for treatment of complex Stanford type B aortic dissection

ObjectivesTo compare the efficacy and prognosis of one-stop hybrid surgery using the elephant trunk procedure for treatment of complex Stanford type B aortic dissection.MethodsWe retrospectively analyzed patients who underwent surgical treatment from January 2014 to July 2019. The patients were divided into those who underwent the elephant trunk procedure (n = 10) and those who underwent one-stop hybrid surgery (n = 10). The cardiopulmonary bypass time, mechanical ventilation time, length of hospital stay, and red blood cell usage were compared between the two groups. All patients’ 3-month postoperative aortic computed tomography angiography (CTA) findings were also reviewed.ResultsThe cardiopulmonary bypass time, mechanical ventilation time, and length of hospital stay were significantly shorter and red blood cell usage was significantly lower in the one-stop hybridization group. The aortic cross-clamp time was not significantly different between the two groups. Aortic CTA review after hybrid surgery showed that the true lumen of the descending aorta was almost completely restored at 3 months.ConclusionOne-stop hybrid surgery effectively alleviated the occlusion of the aortic dissection, prevented the need for additional surgery, and expanded the indications for covered-stent endovascular repair.     

Clinical outcome of staged versus combined treatment approach of hybrid repair of thoracoabdominal aortic aneurysm with visceral vessel debranching and aortic endograft exclusion

Although visceral vessel debranching and endovascular aneurysm exclusion represents a hybrid treatment approach in patients with thoracoabdominal aortic aneurysm, the effect of timing with regard to the visceral debranching procedure and endovascular aneurysm exclusion in this treatment strategy remains unclear. In this study, the authors analyzed their recent institutional experience of visceral debranching and aneurysm stent-grafting procedures. Specifically, the authors compared the effect of staged (n = 27) versus combined (n = 31) hybrid treatment in patients with complex aortic aneurysms. This study showed a higher incidence of renal insufficiency in patients undergoing a combined hybrid repair than the staged hybrid approach. The possibility of aneurysm rupture may exist in the staged treatment approach if the duration of staged repair is prolonged. The combined hybrid treatment strategy should be performed with caution as it is associated with significantly higher complication rates than the staged hybrid treatment modality.     

腹主动脉瘤开放手术与腔内治疗效果的比较

目的比较腹主动脉瘤开放手术与腔内治疗的疗效及安全性。方法回顾性分析腹主动脉瘤患者98例临床资料。开放手术治疗30例,其中择期手术22例、急症手术8例;腔内隔绝术治疗68例,均为择期手术。结果开放手术组死亡1例,术后心力衰竭2例、术后急性心肌梗死1例、呼吸衰竭2例、急性肾衰竭2例。腔内组死亡1例,术后呼吸衰竭1例、脑梗死1例。结论开放手术适于年轻、合并症少及无法行腔内修复术的患者。腔内治疗以其安全、微创、术后恢复快等优点已成为发展趋势。     

Hybrid endovascular and open surgical repair of a Crawford type III thoracoabdominal aneurysm in a high-risk patient

Open thoracoabdominal aortic aneurysm repair carries a risk of significant morbidity and mortality. Thoracic endovascular aortic repair is an alternative, less invasive approach with lower morbidity and mortality but is not an option for thoracoabdominal aortic aneurysm because of visceral artery involvement. The authors describe the treatment of a 61-year-old high-risk male with an enlarging Crawford type III thoracoabdominal aneurysm using simultaneous aortic visceral debranching and thoracoabdominal endovascular aortic repair. A hybrid approach may be a safe alternative treatment option in high-risk surgical patients with thoracoabdominal aortic aneurysm.     

显微镜下颅内动脉瘤夹闭术的手术配合与护理

[目的]探讨显微镜下实施颅内动脉瘤夹闭术的手术配合及护理.[方法]回顾性分析20例颅内动脉瘤夹闭术的手术及护理配合过程.[结果]20例病人手术顺利,术后均取得满意效果.[结论]手术护士术前做好充分的心理准备和物品准备,术中熟练掌握手术器械的使用方法和手术步骤以及术中积极主动地配合是颅内动脉瘤夹闭术的护理重点.     

弹簧圈栓塞颅内动脉瘤介入治疗的护理

目的探讨弹簧圈栓塞颅内动脉瘤介入治疗的护理体会。方法对颅内动脉瘤患者进行规范化、系统、周密的围术期护理,包括术前、术中、术后的护理。结果经过医护人员的精心操作,严密观察和细致护理,62例患者中58例术中及术后未出现颅内动脉瘤破裂,均康复出院。结论采用弹簧圈栓塞介入治疗颅内动脉瘤较传统开颅夹壁手术具有创伤小,并发症少,恢复快,有效降低死亡率的特点,而充分的物品准备,细致的病情观察和术中密切的护理配合及术后并发症的护理,对保证手术成功具有重要作用。