急性A型主动脉夹层合并下肢缺血外科手术疗效分析.PDFVIP

中国胸心血管外科临床杂志 2018 年4 月第25 卷第0 期 • 1 •   ·· 急性 A 型主动脉夹层合并下肢缺血外科手术 疗效分析 崔聪，张力，高夏，张向辉，肖长波，卢伟，武刚，王平凡 河南省胸科医院（郑州  450003 ） 【摘要】   目的     探讨急性 A 型主动脉夹层合并下肢缺血的临床治疗方法。方法     回顾性分析 2012 年 12 月 至 2016 年 12 月期间手术治疗 39 例急性 A 型主动脉夹层合并下肢缺血患者的临床资料，其中男 27 例、女 12 例， 平均年龄（51.4±12.4）岁。所有患者在深低温停循环下行手术治疗。结果     全组患者术后 30 d 内死亡 7 例 （17.9%），术后生存 32 例，随访率 93.8% （30/32 ），术后随访 3 个月～3 年，效果满意。随访患者总体下肢缺血康 复率为 96.7% （29/30 ）。结论     术前应对患者进行全面的评估，合理把握手术指征，积极手术治疗急性 A 型主动 脉夹层合并下肢缺血是安全、可行且有效的，必要时可同期行各类转流手术来帮助重建下肢血运。 【关键词】  主动脉夹层；下肢灌注不良；外科治疗 Clinical analysis of acute type-A aortic dissection with lower limb malperfusion CUI Cong, ZHANG Li, GAO Xia, ZHANG Xianghui, XIAO Changbo, LU Wei, WU Gang, WANG Pingfan Henan Province Chest Hospital, Zhengzhou, 450003, P.R.China Corresponding author: CUI Cong, Email: conghuicui@163.com 【Abstract 】 Objective     To explore the treatment experience of acute type-A aortic dissection with lower limb malperfusion. Methods     From December 2012 to December 2016, 39 patients were diagnosed as acute type-A aortic dissection complicated with lower limb malperfusion and underwent operation.There were 27 males and 12 females with an average age of 51.4±12.4 years. Results     Early mortality rate was 17.9%(7/39). 32 patients of postoperative survival. The follow-up rate was 93.8%(30/32), 3 months to 3 years after the operation, the results is satisfactory. The over lower limb malperfusion recovery rate of follow-up patients was 96.7%(29/30). Conclusion     Positive operation for acute type- A aortic dissection with lower limb malperfusion is safe, feasible and effective.Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary.Comprehensive evaluation of patient’s