DeBakey Ⅰ型主动脉夹层的杂交手术治疗  

Hybrid technique for DeBakey type I aortic dissection

作　　者：郑先杰[1] 张双林[1] 张庄[1] 赵爱国[1] 张国瑜[1] 张筱扬[1] 董彦军[1] 段淑敏[1] 符伟国[2] 郭大乔[2] 

机构地区：[1]河南大学第一附属医院心血管外科,开封475003 [2]复旦大学附属中山医院血管外科

出　　处：《中国医师进修杂志》2010年第29期13-15,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨DeBakey Ⅰ型主动脉夹层行升主动脉并全弓置换加降主动脉支架置入术（即杂交手术）的疗效、适应证的选择和并发症的处理。方法2005年9月至2009年6月，经CT增强扫描或磁共振确诊DeBakeyⅠ型主动脉夹层患者12例，均行杂交手术。术后2、6个月复查胸部CT增强扫描，了解升主动脉、主动脉弓人工血管及降主动脉血管内覆膜支架的情况。结果12例患者全部手术成功，无严重并发症，体外循环时间196～298（264．0±36．6）min。升主动脉阻断时间89～276（213．6±43．8）min，所有患者均顺利出院。术后2个月复查CT增强扫描，提示人工血管通畅，血管内支架无移位，无远端脏器缺血，10例远端假腔消失，血栓形成，2例远端假腔未消失，提示有轻度内瘘。术后6个月复查，2例轻度内瘘均消失。 结论杂交手术是治疗DeBakey Ⅰ型主动脉夹层的有效手段，具有创伤小、并发症少、安全性高等优点，近期疗效满意。Objective To explore the efficacy,indication and the treatment of complication of concomitant thoracic aortic replacement and endoluminal stent grafting （hybrid technique） for DeBakey type I aortic dissection. Methods From September 2005 to June 2009,12 patients with acute DeBakey type I aortic dissection were diagnosed by contrast-enhanced CT or MRI scan, and underwent hybrid technique. Computed tomography angiography （CTA） was performed in each patient at 2,6 months after operation to check up the post-operative course, such as ascending aortic and vascular prosthesis of aortic arch and decending aorta. The time of the post-operational follow-up was 6 -36 months. Results All patients successfully recovered from surgery procedure, no serious complication. The time of cardiopulmonary bypass was 196 - 298 （ 264.0 ± 36.6 ） rain, arrest time of ascending aortic was 89 - 276 （213.6 ± 43.8 ） min. All patients were discharged from hospital. Contrast-enhanced CT or MRI indicated the vascular prosthesis to been unobstructed,no endo-stent dislocation and no organ ischemia, the false lumen and thrombosis disappeared in 10 patients, but false lumen and leakage happened in 2 patients at 2 months after operation. The false lumen disappeared at 6 months after operation. Conclusions Hybrid technique for DeBakey type I aortic dissection is satisfactory in short term effect with less invasiveness and definite safety. However,further studies are needed to evaluate its long-term outcomes.

关 键 词：人工血管 支架 主动脉夹层 杂交手术 

分 类 号：R473.6[医药卫生—护理学]