临床外科杂志 ›› 2020, Vol. 28 ›› Issue (12): 1182-1186.doi: 10.3969/j.issn.1005-6483.2020.12.029

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主动脉腔内隔绝术后脊髓缺血七例治疗体会

  

  1. 611130 四川省成都市第五人民医院普外科(赵伟) ;第二军医大学附属长海医院血管外科(张昊、 张雷、 夏士博、陆清声、 景在平、冯睿、赵志青、 包俊敏);福建省龙岩市第一医院心脏血管外科(张华炜);大理大学第一附属医院普外一科(王志义)
  • 出版日期:2020-12-20 发布日期:2020-12-20
  • 通讯作者: 张雷,Email: dr_lei_zhang@163.com
  • 基金资助:
    上海市优秀青年医师人才基金资助项目

Pathogenesis exploration and treatment experience of 7 cases of spinal cord ischemia after endovascular aortic repair

  1. Department of General Surgery, the Fifth People's Hospital of Chengdu,Sichuan Province,Chengdu 611130,China
  • Online:2020-12-20 Published:2020-12-20

摘要: 目的 总结主动脉腔内隔绝术后脊髓缺血的治疗体会。
方法 2017年11月~2019年11月,我科收治的主动脉腔内隔绝术后发生脊髓缺血(SCI)病人7例,总结手术特点和随访结果,分析可能造成脊髓缺血的危险因素。
结果 术后发生SCI的7例病人均未在术前行预防性脑脊液引流,其中6例病人为早期SCI,1例病人为延迟SCI;术前4例病人存在肾功能不全,6例病人存在血脂异常,3例病人合并慢性阻塞性肺疾病(COPD);平均手术时间为(2.5±1.35)小时;平均主动脉隔绝范围为8个椎体节段;4例病人在术中予以重建分支动脉;术后4例病人行治疗性脑脊液引流。经治疗后,2例病人症状好转,5例病人预后不良,其中4例病人死亡。
结论 SCI是多种因素综合作用的结果,治疗性脑脊液引流的效果有限。

关键词: 脊髓缺血, 腔内隔绝, 脑脊液引流, 截瘫, 分支动脉

Abstract: Objective To explore the mechanism and preventive measures of spinal cord ischemia after endovascular aortic repair.
Methods A analysis of 7 patients with spinal cord ischemia (SCI) after endovascular aortic repair in our department from November 2017 to November 2019 was carried out. By summarizing the surgical characteristics and follow-up results, a comparative analysis of the possible risk factors for spinal cord ischemia,as well as targeted prevention and treatment measures.
Results Seven patients with SCI after endovascular aortic repair did not undergo preventive cerebrospinal fluid drainage, including 6 early SCI and 1 delayed SCI;4 patients with renal insufficiency, 6 patients with dyslipidemia and 3 patients with chronic obstructive pulmonary before operation; the average operation time was 2.5±1.35 hours; the average length of aortic isolation was 8 vertebral segments;4 cases were reconstructed branch arteries during operation; 4 cases were treated with therapeutic cerebrospinal fluid drainage after operation.After treatment,the symptoms improved in 2 cases and the prognosis was poor in 5 cases, including 4 deaths.
Conclusion SCI is the result of a combination of factors,and the therapeutic cerebrospinal fluid drainage has limited effect.

Key words: spinal cord ischemia, endovascular aortic repair, cerebrospinal fluid drainage, paraplegia, branch artery

[1] 梁太平, 裴轶飞, 周建等. 主动脉夹层的治疗现状与未来[J]. 临床外科杂志, 2020, 28(6): 501-503.
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