胸主动脉疾病腔内修复术中封闭左锁骨下动脉的可行性分析  

Feasibility of intentional occlusion of the left subclavian artery in en- dovascular aortic repair of thoracic aortic disease

作　　者：张瑜[1] 郗二平[1] 朱健[1] 朱水波[1] 王荣平[1] 许贵华[1] 殷桂林[1] 

机构地区：[1]广州军区武汉总医院心胸外科,武汉430070

出　　处：《国际外科学杂志》2012年第11期760-762,共3页International Journal of Surgery

基　　金：武汉市科技攻关计划资助项目（No.201161038346）;2010年度军队临床高新技术重大项目（No.2010gxjs036）

摘　　要：目的探讨胸主动脉疾病腔内修复术中封闭左锁骨下动脉的可行性及效果。方法2005年10月-2012年3月广州军区武汉总医院心胸外科对行胸主动脉腔内修复术需要封闭左锁骨下动脉的患者在术前进行脑循环、颈动脉、椎基底动脉及Willis环检查，如右侧椎动脉血供良好，颈动脉、Willis环无狭窄则选择在腔内修复术中直接封闭左锁骨下动脉。术后观察颅脑及上肢缺血并发症发生情况。结果40例患者封闭了左锁骨下动脉，手术均获成功，28例术后未出现左上肢窃血症状和神经系统并发症，12例出现了轻微的左上肢窃血症状及神经系统并发症，但无需手术干预。结论在有意封闭左锁骨下动脉前，必须注意潜在性主动脉弓上各分支动脉的病变和变异，这样才可能保证胸主动脉疾病患者进行主动脉腔内修复术时安全、有效。Objective To investigate the feasibility and effect of intentional occlusion of the left subclavian artery （LSA） in endovascular aortic repair EVAR of thoracic aortic disease. Methods The cases, who needed occlusion of the LSA in EVAR of thoracic aortic disease, were examined cerebral circulation, carotid artery, vertebral basilar artery and circle of Willis. If the vertebral artery had a good blood pathway, and carotid artery and circle of Willis had no stenotic, we occluded the LSA directly in EVAR, and observed the brain and upper limb iscbemia complications postoperation. Results Among 40 cases who were occluded the LSA directly in EVAR, 28 cases were successful with no neurological complications and left upper limb ischemia symptoms postoperation, 12 patients with mild symptoms of subclavian steal syndrome and neurdogical complications, but none required and secondary surgical intervention. Conclusions Prior to intentional LSA occlusion, attention must be paid to potential supraaortic variants and pathologies. Only in this way,it was safe arid effective to occlude the LSA in EVAR of thoracic aortic disease.

关 键 词：主动脉瘤 胸 锁骨下动脉 主动脉夹层 腔内修复术 可行性研究 

分 类 号：R654.3[医药卫生—外科学]