选择性肋间动脉灌注在降主动脉手术中的应用

目的 探讨选择性肋间动脉灌注在降主动脉手术中对脊髓的保护作用.方法 2007年8月至2009年3月,5例降主动脉夹层和2例降主动脉瘤病人行降主动脉置换术.术中保留置换降主动脉上所有肋间动脉,进行选择性肋间动脉灌注,以减少脊髓缺血时间及程度以达到脊髓保护的目的 .术后早期观察和中期随访是否有截瘫发生.结果 术中脊髓缺血23～27 min,平均(24.8±1.6) min.7例术后均未发生截瘫,治愈出院.随访1～19个月,全组无截瘫,生活质量良好.结论 选择性肋间动脉灌注可缩短脊髓缺血时间和程度,脊髓保护效果良好,并可大大降低手术操作难度.

Selective intercostal arterial perfusion during descending aortic surgery

Objective This clinical study evaluated the efficacy of selective intercostal arterial perfusion for protection of spinal cord during descending aortic surgery.Methods From August 2007 to March 2009,7 patients received descending aorta replacement for type B dissection (5 patients) or thoracic aortic aneurysm (2 patients).Descending aorta replacement was performed through a posterolateral incision and left femoral vein-artery bypass in 1 case and left atrial-left femoral artery (LA-FA) bypass in 6.The grafts extended from the distal arch at the root of subclavian artery to the descending aorta at the T10-11 vertebra.The posterior wall of the descending aorta with intercostal arteries was sutured to form an 15 mm tube in diameter and an end-to-side anastomosis was made to an 8 mm graft branch.Selective intercostal arterial perfusion was performed from the T1 intercostal artery to the T10-11 intercostal artery through the 8 mm graft branch to protect spinal cord from ischemia.Cerebrospinal fluid pressure was monitored and cerebrospinal fluid drainage was performed necessarily.Results The replaced grafts measured from 19 to 23 cm mean (20.2±1.4) cm].The CPB duration ranged from73-84 min mean (24.8 ± 1.6) min].The mean ischemic duration was 23 to 27min mean(24.8 ± 1.6) min].There were no perioperative complications.No patients sustained transient or permanent paraplegia in the postoperation or in the follow-up of 1-19 months.Cerebrospinal fluid pressure was 10-14 cmH2Omean (2.2 ± 1.9) cmH2O].The cerebrospinal fluid pressure increased from 5-8 cmH2O mean (6.6±1.3) cmH2O].The cerebrospinal fluid pressure was not decreased after selective intercostal arterial perfusion.Conclusion Selective intercostal arterial perfusion reserved all intercostal arteries and avoided artery steal syndrome.This method could perfuse the intercostal arteries effectively and reduced ischemic duration and degree of spinal cord injury and reduced operative difficulty.This method could afford abundant time to deal with complicated aortic disease while not increasing paraplegia rate.