tangent resection

The thoracic aortic aneurysm is caused by the middle layer damage of the thoracic aorta wall, and the wall of the thoracic aorta is thinned, and expands and expands under the impact of high pressure blood flow in the lumen. The disease is dangerous and the natural prognosis is very poor. Once the symptoms appear, the average life expectancy is only 6-8 months. Surgical treatment is different from the conservative treatment of internal medicine. It is the only treatment that can cure it. Once it is diagnosed, whether it has symptoms or not. Surgical treatment should be performed as soon as possible. The purpose of surgical treatment is to remove the aneurysm, transplant the artificial blood vessels, and restore normal blood supply. Treatment of diseases: thoracic aortic aneurys Indication In a localized cystic aneurysm, the neck (ie, the stenosis of the tumor sac) is less than 1/2 of the diameter of the aorta, the other vessel walls are normal, and there is no serious adhesion to the surrounding important tissues or organs. Contraindications In addition to cystic aneurysms, other types of thoracic aortic aneurysms have a range of violations greater than 1/2 of the diameter of the aorta; or longer longitudinal diameters, aortic stenosis may occur after resection, or left Abnormal aneurysm organizers. Preoperative preparation 1. It is best to do aortic angiography before surgery, to determine the shape of the aneurysm and the extent of the neck of the tumor, and the relationship with the surrounding tissue, to consider whether tangential resection can be done. If the aneurysm is adjacent to the root of the ascending aorta, the left ventricle should be compared with the left and right coronary angiography. 2. Patients with a long history of smoking, in addition to absolutely no smoking for at least 2 weeks before surgery, must do adequate respiratory preparation, control chronic bronchitis, clear secretions of the respiratory tract, keep the airway open. 3. Prepare for extracorporeal circulation. If there is an accident during operation, the aneurysm should be removed in time according to extracorporeal circulation. Surgical procedure Chest incision Because of the cystic aneurysm, mostly located in the anterior wall of the ascending aorta, a median chest incision should be used. For example, in the right or posterior wall of the ascending aorta, a third intercostal incision in the right front chest can also be used. When a midline incision is made, it is generally preferred to use a swinging saw to open the sternum. 2. Exposing and separating aneurysms After opening the chest, slowly open the sternum or chest to prevent tearing the wall. First, the neck of the aneurysm is free, and the extent of the base is clearly defined. If it is possible to perform tangential resection, the inhaled anesthetic and vasodilator drugs are used to reduce the arterial systolic blood pressure to 80-90 mmHg, along the aorta in the neck of the aneurysm. The shaft was slowly clamped with a non-invasive aortic forceps. 3. suture the aneurysm neck Due to the large tissue tension of the arterial wall, the neck of the tumor is cut once, and the vascular clamp is easy to slip off. Therefore, the method of suturing with the edge trimming is safe. Firstly, the 3-0 or 4-0 polypropylene thread was used for continuous or intermittent suture stitching. After the tumor neck was completely cut, the second layer of "8" shape suture was performed. The resected tumor is adhered to the surrounding tissue with sharp separation. If the adhesion is dense for important tissues, part of the wall can be indwelled to avoid damage to adjacent blood vessels and nerves. complication 1. Bleeding is a serious complication during or after the operation, especially in the aneurysm suture. If it is not treated in time, due to excessive hypotension, it can cause cerebral hypoxia, cardiac tamponade, and even cardiac arrest. Stop and wait for serious consequences. 2. Infection can cause infection due to extensive oozing of the wound surface, or poor drainage of the mediastinum and blood in the chest. Therefore, the operation should be completely stopped bleeding, repeated flushing to remove blood; postoperative drainage of drainage is an important measure to prevent infection. 3. Pseudoaneurysm The aortic aneurysm wall is partially torn at the suture, the blood continuously overflows, and is wrapped by extravascular fibrous tissue or adjacent organs to form a hematoma, which is a pseudoaneurysm. As bleeding continues to increase, if it is not detected and treated in time, it may die due to sudden major bleeding.