摘要
目的 目的总结一期杂交手术治疗主动脉弓部病变患者的疗效.方法 2006年2月至2013年8月,采用一期杂交手术治疗27例病变累及主动脉弓部的患者,男18例,女9例;年龄48 ～ 76岁（66.6±8.6）岁.术前诊断主动脉弓部瘤10例,逆撕累及弓部的B型主动脉夹层10例,穿透性溃疡、壁内血肿4例,主动脉弓部假性动脉瘤3例.5例有开胸心脏手术史.术前合并高血压病21例,慢性阻塞性肺疾病7例,2型糖尿病5例,马方综合征2例.并发症有肾功能不全6例,胸腔积液13例,低氧血症15例.应用去分支技术,人工血管建立旁路重建头颈部分支血管血供,然后经股动脉置入降主动脉覆膜支架修复主动脉弓部及降主动脉病变部位,均采用一期手术.近端锚定区0区16例,1区11例.随访6～ 96个月,平均46个月,2例失访.结果 无早期（术后30内和住院）死亡.术后急性肾功能衰竭2例,血液透析治疗后恢复.呼吸衰竭、肺部感染6例,均治愈.2例卒中,1例恢复无后遗症,1例有轻度偏瘫.无截瘫.Ⅰ型内漏2例,3个月后均消失,无需再手术.随访中4例分别于术后10、18、32和38个月死亡.无迟发内漏和逆行主动脉夹层等支架相关并发症.结论 一期杂交手术治疗主动脉弓部病变患者疗效满意,远期效果需进一步随访.
Objective Retrospectively research on the efficacy of one-stage hybrid repair for high-risk aortic arch pathologies.Methods From Feb.2006 to Jun.2013,twenty-seven high-risk patients with aortic arch defects,aged（66.6 ±8.6） years（range 48 to 76）,18（66.7％） males,received one-stage hybrid repair.Aortic pathology included 10 aortic arch aneurysms,10 Stanford type B dissections,3 aortic arch pseudoaneurysms and 4 penetrating ulcer and intramural hematomas.Five （18.5％） patients had a history of cardiac procedures.Preoperative comorbidities included hypertension （21/27,77.8％）,type 2 diabetes（5/27,18.5 ％）,COPD （7/27,25.9％） and Marfan syndrome （2/27,7.4％）.Preoperative complications included renal dysfunction （6/27,22.2％）,chest pleural （13/27,48.1％） and hypoxemia（15/27,55.6％）.Debranching technique through graft bypass was used to complete the revascularization of branch arteries of the aortic arch.And then a TEVARtechnique was utilized to repair the arch lesions with stent grafts.All cases received the debranching and TEVAR procedure in one stage.The proximal landing zone at zone 0 in 16 cases and at zone 1 in 11 cases.Follow-up period ranged from 6 to 96 months,averaged 46 months,with a follow-up rate 92.6％ （2 lost）.Results No early death（including death within 30 postoperative days and death in hospital）.Postoperatively two patients complicated with acute renal failure （needed dialysis） and 6 cases with lung infection and respiratory failure.Stroke were diagnosed in 2 cases,of them one cured and another with mild hemiplegia.Type Ⅰ endoleaks occurred in 2 cases,and disappeared 3 months later without reintervention.There were 4 late deaths occurred in postoperative 10,18,32 and 38 months individually.No late endoleak and retrospective dissection were observed during follow-up.Conelusion One stage hybrid procedure had a good efficacy for high risk patients with aortic arch disease.Further researches are required to confirm the long-term outcomes.
出处
《中华胸心血管外科杂志》
CSCD
2015年第5期293-296,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
主动脉弓
主动脉瘤
主动脉夹层
杂交手术
支架
腔内治疗
Aortic arch
Aortic aneurysm
Aortic dissection
Hybrid procedure
Stent endovascular treatment
