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一期全主动脉置换治疗合并肾功能衰竭的Ⅰ型主动脉夹层

Single-stage replacement of total aorta for type Ⅰ dissection with renal failure

摘要:

目的 探讨对合并肾功能衰竭患者行一期全主动脉置换的可行性.方法 患者男性,43岁,既往为Ⅲ型夹层动脉瘤,1年前行支架型人工血管降主动脉内膜破口封堵术后4个月继发I型 主动脉夹层,患者除左肾动脉外主动脉各主要分支均开口于夹层假腔.本次手术前5个月起因肾功 能衰竭行透析治疗,合并血小板减少.患者在全身麻醉低温心肺转流下一期行从升主动脉至双髂动 脉的全主动脉人工血管置换术.手术时间12 h,术中出血量约9000 ml,术中输血和血浆7300 ml(包 括自体血液回收1500 m1),输血小板800 ml.结果 术后第2天患者四肢可自主活动,术后第4天神志逐步恢复正常,术后1周拔除气管插管.尽管无肾功能恢复,但术后2周CT复查,提示各人工血管和重建的内脏动脉及肋间动脉通畅良好.结论 对于合并肾功能衰竭者可行一期全主动脉置换术.

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abstracts:

Objective To investigate the feasibility of one-stage replacement of total aorta for patient with renal failure.Methotis The patient was male.43 years old The type I aortic dissection was secondary to type Ⅲ aortic dissection 4 months after endovascular treatment of descending aorta using stented graft 1 year ago.All important branches from aorta were irrigated by false lumen of dissection except left renal artery.The patient has been dialyzed because of renal failure before 5 months with low platelets. Single-stage replacement of total aorta from ascending aorta to iliac artery was successful under deep hypothermia and cardiopulmonary bypass.The operation lasted 12 h.Blood loss during operation was 9000 ml and infusion of blood and blood plasma 7300 ml(including 1500 ml of blood retrieval) and blood platelet 800 ml.Results Autonomic activity of four limbs was recovered 2 d after operation.and mind recovered 4 d after surgery.The intubation of trachea Was extracted 1 week after operation.Re-check through CT showed all vascular prostheses and reconstructed viscera]arteries and intercostal arteries were patent though no recovery of renal function.Conclusion One-stage replacement of total aorta for patient with renal failure is feasible.

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