四医大大动脉炎人工血管架桥获成功

2012-04-25 西京医院血管内分泌外科 陈江浩 医学论坛网

  近日,第四军医大学西京医院血管内分泌外科与口腔医院颌面外科联手,成功地为一名高危性大动脉炎合并先天性血管畸形患者实施了左侧髂外动脉-左侧颈内动脉人工血管旁路移植术。经文献检索,该术式为全国首例。   大动脉炎多发于年轻女性,手术复杂,在世界范围罕有成功报道。患者赵某,一年多来头晕乏力,尤其近3个月视物不清、反复晕厥,来到西京医院就诊时只能平卧、无法站立。检查发现患者主动脉弓、头臂动脉、双侧颈

  近日,第四军医大学西京医院血管内分泌外科与口腔医院颌面外科联手,成功地为一名高危性大动脉炎合并先天性血管畸形患者实施了左侧髂外动脉-左侧颈内动脉人工血管旁路移植术。经文献检索,该术式为全国首例。

  大动脉炎多发于年轻女性,手术复杂,在世界范围罕有成功报道。患者赵某,一年多来头晕乏力,尤其近3个月视物不清、反复晕厥,来到西京医院就诊时只能平卧、无法站立。检查发现患者主动脉弓、头臂动脉、双侧颈总动脉等多处严重狭窄或闭塞,大脑严重缺血,随时有生命危险。

  西京医院对该罕见病例非常重视,多次组织西京医院心脏外科、麻醉科、免疫科、神经内科和口腔医院颌面外科等相关学科的专家教授会诊。患者供应大脑的四根血管,已有三根完全闭塞,仅左侧颈内动脉在即将入颅前有大约2cm长度相对正常,患者平时仅靠这一根血管维持大脑灌注,这是做血管架桥的唯一着陆点。手术如同在一根钢丝上舞蹈,难度极高,稍有不慎,即可导致死亡或瘫痪。

  经过充分的术前准备,麻醉科主任董海龙给予全麻插管诱导成功后,血管内分泌外科王岭教授和口腔医院颌面外科余擘教授主刀实施手术。术中发现患者还存在先天性血管畸形,颈动脉分叉位置极高,病变已累及全段颈总动脉和颈外动脉,对血流控制和血管吻合增加了新的难度。此外,患者足背动脉与颈内动脉收缩压超过以往类似手术平均压力差的两倍,加大了术后发生急性脑水肿的风险。手术团队密切配合,将直径8毫米、长达70厘米的人工血管经皮下隧道置入患者体内,分别进行人工血管与左侧髂外动脉、左侧颈内动脉的血管吻合术,将患者下半身的血经人工血管引入颅内。手术期间克服了术中脑缺血、缺血再灌注性脑水肿、急性血栓形成、移植物排斥、血栓或斑块脱落等导致偏瘫甚至死亡等技术难题。

  经过5个多小时的艰苦奋战,这一世界性高难度手术圆满完成。目前,患者恢复顺利,神志清楚,四肢活动正常,头晕消失,视觉恢复,各项生命体征平稳。



    

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    2013-03-11 xsm927
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