单一胸骨上段小切口行全弓置换手术的体外循环管理
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摘要
目的探讨采用单一胸骨上段第4肋间小切口行主动脉弓部置换手术的体外循环管理的可行性与安全性。方法回顾分析2016年5月至2018年4月共153例行主动脉弓部置换手术的患者,其中男性115例,女性38例。根据手术方式分为胸骨上段小切口组(UHS组,n=73)和传统切口组(FS组,n=80)。UHS组采用经单一胸骨上段第4肋间小切口完成手术; FS组采用胸骨正中切口完成手术,记录两组围术期各种参数。结果两组患者均顺利完成手术,术中UHS组停循环时间显著长于FS组[(34.9±8.2) min vs.(32.5±6.0) min,P <0.05];术后呼吸机辅助时间(31.3±8.7) h vs.(42.9±10.2) h,P <0.05]和ICU停留时间[(51.3±19.2) h vs.(71.2±29.8) h,P <0.05]UHS组显著少于FS组。其余各临床指标两组间无显著差异。结论经胸骨上段小切口行主动脉弓部置换手术的体外循环管理安全、可行,该手术可能有利于患者术后尽快恢复。
Objective To evaluate the feasibility and safety of cardiopulmonary bypass managerment for total arch replacement through upper hemisternotomy approach. Methods 153 patients( 115 males and 38 females) undergoing total arch replacement surgery were included in this study. They were divided into UHS group and FS group according to the selection of incisions( UHS group:upper hemisternotomy,FS group: sternotomy). Perioperative characteristics were recorded. Results All cases were successfully undertaken. The time of circulatory arrest in UHS group was significantly longer than that in FS group( 34.9±8.2 min vs. 32.5±6.0 min,P <0.05). However,the time of ventilation( 31.3±8.7 h vs. 42.9±10.2 h,P <0.05) and the length of ICU stay( 51. 3 ± 19. 2 h vs.71.2±29.8 h,P <0.05) were significantly shorter in UHS group compared with those in FS group. There was no difference between the two groups in other periopertive characteristics. Conclusion Management of cardiopulmonary bypass for the procedure of total arch replacement through upper hemisternotomy approach is safe and feasible. Total arch replacement surgery throungh upper hemisternotomy approach may benefit patients' recovery.
Objective To evaluate the feasibility and safety of cardiopulmonary bypass managerment for total arch replacement through upper hemisternotomy approach. Methods 153 patients( 115 males and 38 females) undergoing total arch replacement surgery were included in this study. They were divided into UHS group and FS group according to the selection of incisions( UHS group:upper hemisternotomy,FS group: sternotomy). Perioperative characteristics were recorded. Results All cases were successfully undertaken. The time of circulatory arrest in UHS group was significantly longer than that in FS group( 34.9±8.2 min vs. 32.5±6.0 min,P <0.05). However,the time of ventilation( 31.3±8.7 h vs. 42.9±10.2 h,P <0.05) and the length of ICU stay( 51. 3 ± 19. 2 h vs.71.2±29.8 h,P <0.05) were significantly shorter in UHS group compared with those in FS group. There was no difference between the two groups in other periopertive characteristics. Conclusion Management of cardiopulmonary bypass for the procedure of total arch replacement through upper hemisternotomy approach is safe and feasible. Total arch replacement surgery throungh upper hemisternotomy approach may benefit patients' recovery.
引文
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[9]郭震,徐凌峰,常昕,等. Stanford-A型主动脉夹层外科治疗的动脉插管策略及评价———附85例报道[J].中国体外循环杂志,2014(1):37-42.
[10] Baek WK,Kim YS,Lee M,et al. Axillary artery cannulation in acute aortic dissection:a word of caution[J]. Ann Thorac Surg,2016,101(4):1573-1574.
[11] Dieberg G,Smart NA,King N. Minimally invasive cardiac surgery:a systematic review and meta-analysis[J]. Int J Cardiol,2016,223:554-560.
[2] Benedetto U,Mohamed H,Vitulli P,et al. Axillary versus femoral arterial cannulation in type a acute aortic dissection:evidence from a meta-analysis of comparative studies and adjusted risk estimates[J]. Eur J Cardiothorac Surg,2015,48(6):953-959.
[3] Tsiouris A,Elkinany S,Ziganshin BA,et al. Open seldingerguided femoral artery cannulation technique for thoracic aortic surgery[J]. Ann Thorac Surg,2016,101(6):2231-2235.
[4] El-Sayed Ahmad A,Risteski P,Papadopoulos N,et al. Minimally invasive approach for aortic arch surgery employing the frozen elephant trunk technique[J]. Eur J Cardiothorac Surg,2016,50(1):140-144.
[5] Malaisrie SC,Barnhart GR,Farivar RS,et al. Current era minimally invasive aortic valve replacement:techniques and practice[J]. J Thorac Cardiovasc Surg,2014,147(1):6-14.
[6] Waterford SD,Rastegar M,Juan V,et al. Aortic Hemiarch Replacement through a j-shaped lower partial sternotomy[J]. Tex Heart Inst J,2015,42(6):582-584.
[7] Deschka H,Erler S,Machner M,et al. Surgery of the ascending aorta,root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy:results of 50 consecutive cases[J]. Eur J Cardiothorac Surg,2013,43(3):580-584.
[8] Totaro P,Carlini S,Pozzi M,et al. Minimally invasive approach for complex cardiac surgery procedures[J]. Ann Thorac Surg,2009,88(2):462-466.
[9]郭震,徐凌峰,常昕,等. Stanford-A型主动脉夹层外科治疗的动脉插管策略及评价———附85例报道[J].中国体外循环杂志,2014(1):37-42.
[10] Baek WK,Kim YS,Lee M,et al. Axillary artery cannulation in acute aortic dissection:a word of caution[J]. Ann Thorac Surg,2016,101(4):1573-1574.
[11] Dieberg G,Smart NA,King N. Minimally invasive cardiac surgery:a systematic review and meta-analysis[J]. Int J Cardiol,2016,223:554-560.
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