胸腹主动脉瘤开放修复脊髓保护策略的研究进展

doi:10.6040/j.issn.1671-7554.0.2024.0308

摘要/Abstract

摘要： 胸腹主动脉瘤(thoracoabdominal aortic aneurysm, TAAA)是一种极其凶险的疾病,开放手术是其治疗的金标准。几十年来,尽管外科技术和辅助手段已取得长足进步,但由于TAAA开放修复手术时间长、创伤大,围术期并发症发生率一直居高不下。脊髓损伤是其中最严重的并发症之一,通常会导致截瘫、下肢轻瘫等难以接受的结局,因此TAAA开放修复围术期脊髓保护策略一直是学者们研究的重点。本文就TAAA开放修复中脊髓保护策略的研究进展进行综述。

关键词: 胸腹主动脉瘤, 开放修复, 脊髓损伤, 脊髓保护

Abstract: Thoracoabdominal aortic aneurysm(TAAA)is an extremely dangerous disease, and open surgery has been the gold standard for its treatment. In the past decades, despite significant advances in surgical techniques and adjuncts, the incidence of perioperative complications has remained high due to the lengthy and traumatic nature of open repair surgery for TAAA. Spinal cord injury is one of the most serious complications, which usually lead to unacceptable outcomes such as paraplegia and paraparesis of lower limbs. Therefore, the perioperative spinal cord protection strategies in open repair of TAAA have been the focus of scholars research. This review discussed the research progress of spinal cord protection strategies in open repair of TAAA.

Key words: Thoracoabdominal aortic aneurysm, Open repair, Spinal cord injury, Spinal cord protection

中图分类号:

R543.1

周永康,孙境,张帅,钱向阳. 胸腹主动脉瘤开放修复脊髓保护策略的研究进展[J]. 山东大学学报 (医学版), 2024, 62(9): 49-54.

ZHOU Yongkang, SUN Jing, ZHANG Shuai, QIAN Xiangyang. Progress in spinal cord protection strategies for open repair of thoracoabdominal aortic aneurysms[J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 49-54.

参考文献

[1] Crawford ES, Snyder DM, Cho GC, et al. Progress in treatment of thoracoabdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries[J]. Ann Surg, 1978, 188(3): 404-422.
[2] Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs[J]. J Thorac Cardiovasc Surg, 2016, 151(5):1323-37.
[3] Moulakakis KG, Karaolanis G, Antonopoulos CN, et al. Open repair of thoracoabdominal aortic aneurysms in experienced centers[J]. J Vasc Surg, 2018, 68(2): 634-645.
[4] Amato ACM, Stolf NAG. Preoperative assessment of the spinal cord vasculature[M] // Tshomba Y, Baccellieri D, Chiesa R. Visceral Vessels and Aortic Repair. Cham: Springer, 2019: 285-295.
[5] Amabile A, Lewis E, Costa V, et al. Spinal cord protection in open and endovascular approaches to thoracoabdominal aortic aneurysms[J]. Vascular, 2023, 31(5): 874-883.
[6] Arora L, Hosn MA. Spinal cord perfusion protection for thoraco-abdominal aortic aneurysm surgery[J]. Curr Opin Anaesthesiol, 2019, 32(1): 72-79.
[7] Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical practice guidelines[J]. Circulation, 2022, 146(24): e334-e482.
[8] Dong XH, Ge YP, Wang R, et al. Spinal cord protection of aorto-iliac bypass in open repair of extent II and III thoracoabdominal aortic aneurysm[J]. Heart Lung Circ, 2022, 31(2): 255-262.
[9] 梁刚柱,张韬,张杨.胸腹主动脉瘤内脏动脉分支重建专家共识[J].血管与腔内血管外科杂志, 2023, 9(4): 385-394. LIANG Gangzhu, ZHANG Tao, ZHANG Yang. Expert consensus on reconstruction of visceral arterial branches in thoracoabdominal aortic aneurysm[J]. Journal of Vascular and Endovascular Surgery, 2023, 9(4): 385-394.
[10] Miller LK, Patel VI, Wagener G. Spinal cord protection for thoracoabdominal aortic surgery[J]. J Cardiothorac Vasc Anesth, 2022, 36(2): 577-586.
[11] Authors/Task Force Members, Czerny M, Grabenwöger M, et al. EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ[J]. Ann Thorac Surg, 2024: S0003-S4975(24)00077-8. doi:10.1016/j.athoracsur.2024.01.021.
[12] Etz CD, Weigang E, Hartert M, et al. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery[J]. Eur J Cardiothorac Surg, 2015, 47(6): 943-957.
[13] Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2014, 35(41): 2873-2926.
[14] Bisdas T, Panuccio G, Sugimoto M, et al. Risk factors for spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms[J]. J Vasc Surg, 2015, 61(6): 1408-1416.
[15] Zangrillo A, Buratti L, Carozzo A, et al. Intrathecal lactate as a predictor of early- but not late-onset spinal cord injury in thoracoabdominal aneurysmectomy[J]. J Cardiothorac Vasc Anesth, 2014, 28(3): 473-478.
[16] Zhang L, Sun XG, Yu CT, et al. Intercostal artery reconstruction: the simple and effective technique on spinal cord protection during thoracoabdominal aortic replacement[J]. Ann Vasc Surg, 2016, 34: 62-67. doi:10.1016/j.avsg.2015.12.030.
[17] Okita Y. Fighting spinal cord complication during surgery for thoracoabdominal aortic disease[J]. Gen Thorac Cardiovasc Surg, 2011, 59(2): 79-90.
[18] Hsu CC, Kwan GN, van Driel ML, et al. Distal aortic perfusion during thoracoabdominal aneurysm repair for prevention of paraplegia[J]. Cochrane Database Syst Rev, 2012(3): CD008197. doi:10.1002/14651858.CD008197.pub2.
[19] 胡海瓯, 朱俊明, 郑铁,等. 股股转流下胸腹主动脉瘤的外科治疗[J]. 中国心血管病研究, 2023, 21(5): 385-389. HU Haiou, ZHU Junming, ZHENG Tie, et al. Surgical treatment of thoracoabdominal aortic aneurysm under femoral-femoral bypass[J]. Chinese Journal of Cardiovascular Research, 2023, 21(5): 385-389.
[20] Etz CD, Halstead JC, Spielvogel D, et al. Thoracic and thoracoabdominal aneurysm repair: is reimplantation of spinal cord arteries a waste of time?[J]. Ann Thorac Surg, 2006, 82(5): 1670-1677.
[21] Lee JH, Kim H, Chang HW, et al. Incidence of spinal cord ischemia according to the patency of reimplanted segmental arteries during thoracoabdominal aortic replacement[J]. J Cardiovasc Surg, 2022, 63(1): 37-43.
[22] Geisbüsch S, Stefanovic A, Koruth JS, et al. Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model[J]. J Thorac Cardiovasc Surg, 2014, 147(1): 220-226.
[23] Etz CD, Debus ES, Mohr FW, et al. First-in-man endovascular preconditioning of the paraspinal collateral network by segmental artery coil embolization to prevent ischemic spinal cord injury[J]. J Thorac Cardiovasc Surg, 2015, 149(4): 1074-1079.
[24] Doukas P, Gombert A, Kotelis D, et al. Motor evoked potential-guided segmental artery revascularization during open thoracoabdominal aortic aneurysm surgery after coil embolization as a part of the minimally invasive staged segmental artery coil embolization concept[J]. J Vasc Surg Cases Innov Tech, 2022, 8(2): 206-209.
[25] Tanaka A, Nguyen H, Smith HN, et al. Neuromonitoring for descending thoracic and thoracoabdominal aortic aneurysm repair[J]. Ann Cardiothorac Surg, 2023, 12(5): 509-510.
[26] Keyhani K, Miller CC 3rd, Estrera AL, et al. Analysis of motor and somatosensory evoked potentials during thoracic and thoracoabdominal aortic aneurysm repair[J]. J Vasc Surg, 2009, 49(1): 36-41.
[27] Banga PV, Oderich GS, Reis de Souza L, et al. Neuromonitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits to minimize risk of spinal cord injury during complex endovascular aortic repair[J]. J Endovasc Ther, 2016, 23(1): 139-149.
[28] Kise Y, Kuniyoshi Y, Ando M, et al. Direct monitoring of reconstructed segmental arterial pressure during deep hypothermic thoracoabdominal aortic aneurysm surgery[J]. Ann Vasc Dis, 2019, 12(4): 537-540.
[29] Gombert A, Ketting S, Rückbeil MV, et al. Perioperative and long-term outcome after ascending aortic and arch repair with elephant trunk and open thoracoabdominal aortic aneurysm repair[J]. J Vasc Surg, 2022, 75(3): 824-832.
[30] 谢燕,宋怡,管玉龙.胸腹主动脉瘤外科手术围术期管理的研究进展[J/OL].中国胸心血管外科临床杂志: 2023. doi:10.7507/1007-4848.202302045.
[31] Tanaka A, Smith HN, Safi HJ, et al. Open treatments for thoracoabdominal aortic aneurysm repair[J]. Methodist Debakey Cardiovasc J, 2023, 19(2): 49-58.
[32] Martin DJ, Martin TD, Hess PJ, et al. Spinal cord ischemia after TEVAR in patients with abdominal aortic aneurysms[J]. J Vasc Surg, 2009, 49(2): 302-306.

相关文章 15

[1]	刘东,朱冬昀,彭长亮,张程,赵杰,高春正. 脊髓损伤修复的复合透明质酸水凝胶支架的构建及其评价[J]. 山东大学学报（医学版）, 2017, 55(9): 53-59.
[2]	陈磊,刘东晓,李开鸣,宋新强,曾宪思,蒋丽杰. 有序胶原材料联合CBD-BDNF对大鼠脊髓损伤的修复作用[J]. 山东大学学报（医学版）, 2017, 55(5): 43-48.
[3]	李红志,刘静,宋岩,迟令懿,刘玉光. 利拉鲁肽对脊髓损伤修复作用的探讨[J]. 山东大学学报（医学版）, 2016, 54(4): 1-5.
[4]	牟乐明1，孙占胜1，王伯珉1，高平2，初向全3. 骨髓间充质干细胞移植对脊髓损伤大鼠Toll样受体4表达的影响[J]. 山东大学学报（医学版）, 2014, 52(1): 37-41.
[5]	李旭，秦东京，曹新山，姜兴岳，张迪，王静. 无骨折脱位型颈脊髓损伤DTI征象与JOA评分的相关性[J]. 山东大学学报(医学版), 2013, 51(1): 83-87.
[6]	张慧，郭雨霁，郝爱军，马保华. 粒细胞集落刺激因子对急性脊髓损伤中小胶质细胞的作用[J]. 山东大学学报(医学版), 2012, 50(5): 10-.
[7]	刘杨，苗宇船. 滋补脾阴方药对大鼠脊髓损伤后脑源性神经营养因子表达的影响[J]. 山东大学学报(医学版), 2012, 50(10): 33-36.
[8]	刘晓阳，孙建民，崔新刚，蒋振松. 鞘内注射VEGF对大鼠脊髓损伤后神经纤维和神经元的保护作用[J]. 山东大学学报(医学版), 2011, 49(4): 38-42.
[9]	赵伟. 电针对脊髓损伤后硫酸软骨素蛋白多糖表达的影响[J]. 山东大学学报(医学版), 2011, 49(3): 73-.
[10]	赵伟. 电针对脊髓损伤后硫酸软骨素蛋白多糖表达的影响[J]. 山东大学学报(医学版), 2011, 49(3): 73-.
[11]	朱俊德1，余资江1，刘鲜林2，常傲霜2. 大鼠脊髓全横断损伤后不同时间的组织改变[J]. 山东大学学报(医学版), 2011, 49(1): 43-47.
[12]	刘洋，贾堂宏，龚维明，宁斌，郭舒亚，宋宏亮，徐鹏，张涛，张来波 . 脊髓损伤后大鼠水钠代谢紊乱动物模型的建立[J]. 山东大学学报(医学版), 2009, 47(03): 53-55.
[13]	侯勇,聂林,吴琦,邵军,吕丽红 . 兔急性脊髓损伤后磁刺激运动诱发电位与病理变化的相关性[J]. 山东大学学报(医学版), 2008, 46(9): 855-858.
[14]	谢晓,高建新,刘克敬,禹卉,杨贵忠 . 大鼠脊髓损伤后坐骨神经电生理学以及损伤脊髓GAP-43蛋白表达的变化[J]. 山东大学学报(医学版), 2007, 45(5): 474-477.
[15]	蔡中续,李玉华,祁磊,潘新. 嗅粘膜源性嗅鞘细胞移植联合NGF对脊髓损伤的修复[J]. 山东大学学报(医学版), 2007, 45(5): 470-473.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed