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find Keyword "胸主动脉" 28 results
  • 降主动脉置换治疗局部晚期食管癌一例

    Release date:2017-03-24 03:45 Export PDF Favorites Scan
  • Surgical treatment of retrograde type A aortic dissection after thoracic endovascular aortic repair for Stanford type B aortic dissection

    Objective To analyze the etiologies, surgical treatment and outcomes of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. Methods The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed. All patients were followed-up by clinic interview or telephone. Results A total of 16 patients were enrolled, including 13 males and 3 females with a mean age of 49.1±12.2 years. The main symptoms of RTAD were chest pain in 12 patients, headache in 1 patient, conscious disturbance in 1 patient, and asymptomatic in 2 patients. All the 16 patients received total arch replacement with the frozen elephant trunk technique. Bentall procedure was used in 2 patients, aortic root plasticity in 10 patients and aortic valve replacement in 1 patient. The primary tear in 10 patients was located in the area which were anchored by bare mental stent, and in the other 6 patients it was located in the anterior part of ascending aorta. The mean cardiopulmonary bypass time was 152.2±29.4 min, aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min. There was no death in hospital or within postoperative 30 days. The follow-up period was 32-85 (57.4±18.3) months. No death occurred during the follow-up period. One patient underwent TEVAR again 3 years after this operation and had an uneventful survival. Conclusion Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for Stanford type B aortic dissection.

    Release date:2023-09-27 10:28 Export PDF Favorites Scan
  • Effect of PDCA circulation management on pain, psychology and prognosis of patients with thoracic aortic aneurysm in the perioperative period

    ObjectiveTo investigate the effect of PDCA circulation management on pain, psychology and prognosis of patients with thoracic aortic aneurysm in the perioperative period.Methods The clinical data of seventy-six patients with thoracic aortic aneurysm who received perioperative nursing based on PDCA circulation management from April 2016 to March 2017 were retrospective analyzed and these patients were selected as the study group, including 44 males, 32 females, aged 23–65 (47.27±5.87) years. At the same time, 72 patients with thoracic aortic aneurysm who received routine perioperative nursing from April 2015 to March 2016 were selected as the control group, including 41 males, 31 females, aged 24–67 (48.30±5.26) years. The nursing effects of the two groups were compared and analyzed.ResultsThe operation time (t=11.342, P<0.05) and hospitalization time (t=5.986, P<0.05) of the study group were significantly shorter than those of the control group. The visual analogue scale (VAS) scores of the two groups had no significant difference before nursing (t=0.914, P=0.361), but the VAS scores in the study group after nursing were obviously lower than those in the control group (t=5.475, P<0.05). The self-rating depression scale (SDS, t=1.026, P=0.307) and self-rating anxiety scale (SAS) scores (t=7.866, P<0.05) of the two groups had no significant difference before nursing, while the SDS (t=7.657, P<0.05) and SAS (t=7.866, P<0.05) scores in the study group after nursing were obviously lower than those in the control group. The incidence of adverse reactions in the study group was significantly lower than that in the control group (χ2=4.292, P=0.038).ConclusionPDCA circulation management used in patients with thoracic aortic aneurysm in the perioperative period can effectively relieve patients' pain, depression and anxiety, reduce the incidence of adverse reactions, and the prognosis is good.

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  • Surgical Treatment of Bicuspid Aortic Valve Combined with Toracic Aortic Dilation

    ObjectiveTo analyze the clinical characteristics and surgical treatment of bicuspid aortic valve combined with thoracic aortic dilation. MethodsWe retrospectively analyzed the clinical data of 68 patients of bicuspid aortic valve combined with thoracic aortic dilation underwent surgical treatment in our hospital between January 2010 and June 2014. There were 47 males and 21 females at age of 26-77(44.5±16.3) years. Different surgical treatments including Wheat procedure(n=22), aortic valve replacement+ascending aortoplasty(n=10), Bentall procedure(n=13), aortic valve replacement+ascending aortic replacement+right hemi aortic arch replacement(n=13), Bentall procedure+ascending aortic replacement+right hemi aortic arch replacement(n=8), Bentall procedure+ascending aortic replacement+total arch replacement+stented elephant trunk(n=2) were carried out according to the type. ResultsAll 68 patients underwent surgical treatment. The mortality in hospital is at 4.4%(3/68). The postoperative complications were neurological and mental complications(n=3), pneumonia(n=2), and exploratory thoracotomy(n=2). We followed up 63 patients for 6 months to 4 years. A total of 62 patients were well without reoperation except one death at the end of following-up 2 years. ConclusionBicuspid aortic valve combined with thoracic aortic dilation has diversiform clinical characteristics. The surgical treatment should be chosen according to the aortic valve and thoracic aortic lesion characteristics.

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  • 胸主动脉瘤及主动脉夹层外科治疗进展

    胸主动脉瘤及主动脉夹层病情凶险,死亡率和病残率均很高.近几年在保留和不保留主动脉瓣的主动脉根重建术治疗升主动脉瘤,弓部主动脉瘤切除与脑保护,胸主动脉瘤或胸腹主动脉瘤切除与脊髓保护,以及主动脉腔内支架移植术等方面取得了较大的进展.手术死亡率已从31.4%下降至3.3%~4.8%.胸主动脉瘤,特别是主动脉夹层系一全身性主动脉病变,近年来手术疗效有所改善,但远期复发率和再手术率仍较高.主动脉内支架移植与外科手术结合应用,对复杂的伴有降主动脉病变的A型主动脉夹层治疗,可能是一种安全而有效的方法.

    Release date:2016-08-30 06:30 Export PDF Favorites Scan
  • Effectiveness and predictive value of computer finite element modeling of thoracic endovascular aortic repair based on hemodynamics

    Objective To explore the effectiveness and predictive value of computer simulated thoracic endovascular aortic repair (TEVAR). Methods The clinical data of the patients with Stanford type B aortic dissection who underwent TEVAR from February 2019 to February 2022 in our hospital was collected. According to whether there was residual false cavity around the stent about 1 week after TEVAR, the patients were divided into a false cavity closure group and a false cavity residual group. Based on computer simulation, personalized design and three-dimensional construction of the stent framework and covering were carried out. After the stent framework and membrane were assembled, they were pressed and placed into the reconstructed aortic dissection model. TEVAR computer simulation was performed, and the simulation results were analyzed for hemodynamics to obtain the maximum blood flow velocity and maximum wall shear stress at the false lumen outlet level at the peak systolic velocity of the ventricle, which were compared with the real hemodynamic data of the patient after TEVAR surgery. The impact of hemodynamics on the residual false lumen around the stent in the near future based on computer simulation of hemodynamic data after TEVAR surgery was further explored. Results Finally a total of 28 patients were collected, including 24 males and 4 females aged 53.390±11.020 years. There were 18 patients in the false cavity closure group, and 10 patients in the false cavity residual group. The error rate of shear stress of the distal decompression port of the false cavity after computer simulation TEVAR was 6%-25%, and the error rate of blood flow velocity was 3%-31%. There was no statistical difference in age, proportion of male, history of hypertension, history of diabetes, smoking history, prothrombin time or activated partial thromboplatin time at admission between the two groups (all P>0.05). The blood flow velocity and shear stress after TEVAR were statistically significant (all P<0.05). The maximum shear stress (OR=1.823, P=0.010) of the false cavity at the level of the distal decompression port after simulated TEVAR was an independent risk factor for the residual false cavity around the stent. Receiver operating characteristic curve analysis showed that the area under the curve corresponding to the maximum shear stress of false cavity at the level of distal decompression port after simulated TEVAR was 0.872, the best cross-sectional value was 8.469 Pa, and the sensitivity and specificity were 90.0% and 83.3%, respectively. Conclusion Computers can effectively simulate TEVAR and perform hemodynamic analysis before and after TEVAR surgery through simulation. Maximum shear stress at the decompression port of the distal end of the false cavity is an independent risk factor for the residual false cavity around the stent. When it is greater than 8.469 Pa, the probability of residual false cavity around the stent increases greatly.

    Release date:2024-01-04 03:39 Export PDF Favorites Scan
  • 胸主动脉瘤的外科治疗

    目的 总结 19例胸主动脉瘤患者的外科治疗经验。 方法  19例胸主动脉瘤患者 ,其中升主动脉瘤 9例 (马方综合征 8例 ) ,7例行 Bentall手术 ,2例行 Cabrol手术 ;降主动脉瘤 10例 ,均行降主动脉置换术。 结果 除 1例患者术中死亡外 ,其余患者经超声心动图检查均示主动脉瓣关闭良好 ,移植的冠状动脉、降主动脉通畅 ,无扭曲 ,无脊髓损伤和神经系统并发症。随访 18例 ,随访时间 0 .3~ 5 .4年 ,心功能恢复至 级 3例 , 级 15例 ,效果满意。 结论 手术治疗胸主动脉瘤安全有效。

    Release date:2016-08-30 06:28 Export PDF Favorites Scan
  • Castor stent implantation combined with subclavian artery bypass grafting for the treatment of aortic arch lesions

    ObjectiveTo explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. MethodsA retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with carotid-subclavian bypass at the Department of Cardiac Surgery, Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. ResultsA total of 22 patients were included, including 19 males and 3 females, with an average age of 56±16 years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was 10±4 days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, renal insufficiency, etc., and all patients had no readmissions. ConclusionFor proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve good short- and mid-term efficacy.

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  • 3D打印辅助复杂胸主动脉血管病变分支支架腔内修复手术治疗的临床分析

    目的探讨 3D 打印辅助复杂胸主动脉血管病变 Castor 分支支架腔内修复手术治疗的可行性。方法纳入 2018 年 9~12 月急性 Stanford B 型主动脉夹层或主动脉弓部血管病变拟行腔内介入支架手术的 4 例患者,年龄分别为 65、55、45、39 岁。患者均缺乏足够的左锁骨下近端锚定区,或病变累及弓部血管无法采用常规单纯支架置入术。手术均采用 Castor 分支支架,术前采用三维 CT 血管造影(3D-CTA)及 3D 打印技术对主动脉弓部血管解剖进行精确刻画,并辅助手术策略制定及进行器械模拟植入。结果3 例为累及左锁骨下动脉的 Stanford B 型夹层(1 例合并升主动脉瘤),1 例为主动脉弓部穿通性溃疡。4 例患者手术顺利,1 例患者同期行体外循环升主动脉置换。患者术后 CTA 提示效果满意,无内漏、支架移位及卒中等严重并发症出现,30 d 随访患者状态良好,无不良严重并发症出现。结论3D 打印辅助复杂胸主动脉血管病变分支支架腔内修复手术具有很好的可行性及诸多潜在优势。

    Release date:2020-02-26 04:33 Export PDF Favorites Scan
  • Advancements in the treatment of chronic thoracoabdominal aortic dissection

    Aortic dissection is a disease with high mortality rates. Due to the urgency of time, the diagnosis, treatment processes, and strategies of acute aortic dissection follow specific guidelines. However, patients with chronic aortic dissection are often neglected. Choosing the best medication therapy and surgical interventions remains challenging, and there is still a lack of guideline recommendations. With the improvement of imaging diagnostic methods for aortic diseases, the progress of endovascular surgical techniques, and the development of new endovascular graft devices in recent years, clinical data of the treatment of chronic aortic dissection is also gradually increasing. This article summarized the current new technologies and clinical research results for the diagnosis and treatment of chronic aortic dissection, aiming to provide new suggestions for the diagnosis and treatment of chronic aortic dissection.

    Release date:2024-06-20 05:33 Export PDF Favorites Scan
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