主动脉弓部夹层杂交手术的误区与体会  

The misunderstanding and comprehension of hybrid operation for treating aortic dissection involving aortic arch

作　　者：任昊[1] 慈红波[1] 管圣[1] 方青波[1] 赛力木[1] 戈小虎[1] 

机构地区：[1]新疆维吾尔自治区人民医院血管外科,乌鲁木齐830001

出　　处：《中国医师杂志》2014年第3期315-318,共4页Journal of Chinese Physician

摘　　要：目的 探讨杂交手术治疗累及主动脉弓部的主动脉夹层的误区及体会.方法 自2009年3月至2013年11月,对新疆维吾尔自治区人民医院13例累及主动脉弓部的主动脉夹层患者完成了杂交手术治疗.其中男11例,女2例,年龄36 ～ 60（44 ±6.8）岁.均为Stanford B型夹层,病变均累及主动脉弓,不适宜单纯行腔内隔绝治疗.采用胸骨正中切口加颈部切口行升主动脉至头臂干动脉及左颈总动脉旁路移植,2例加做左锁骨下动脉旁路移植,然后行股动脉切口逆行主动脉腔内覆膜支架植入.术后3、9个月、1年及每年随访CT资料,观察支架移位和人工血管通畅情况.结果 所有患者均成功完成血管旁路手术,并植入覆膜支架.术中血管造影证实支架植入定位准确,1例存在内漏,其余患者无明显内漏和移位.主动脉夹层真腔血流恢复正常,旁路血管血流通畅,围手术期无死亡和严重并发症发生.随访13例,随访时间3～56（29.0±10.2）个月,所有患者均生存,并恢复正常生活.术后复查主动脉CT血管造影（CTA）示：1例存在内漏,其余患者支架无移位和内漏,支架内及人工血管旁路血流通畅,未见脑部和肢体的缺血征象.结论 针对主动脉弓杂交手术的特点,总结误区及经验,经过不断摸索,形成一套较为合理的手术治疗方案,对于复杂主动脉夹层能够提高手术的成功率,取得较好的手术效果.Objective To explore the misunderstanding and comprehension of hybrid operation for treating aortic dissection involving aortic arch. Methods From March 2009 to November 2013, 13 patients received hybrid operation for aortic dissection involving aortic arch in the People＇s Hospital of Xinjiang Urgur Autonomous Region were enrolled, including male 11 and female 2, and aged 36 - 60 years old with a mean age （44 ± 6. 8） years old. All patients were type-B aortic dissection. All of them were not suitable to be treated with endovascular exclusion monotherapy. The ascending aorta -brachiocephalic artery bypass and left carotid artery bypass was established with median sternotomy approach and neck incision in 13 patients, and 2 patients did left subclavian artery bypass ad- ditionally, then retrograde endovascular stent graft implantation was used. Computed tomography angiography （CTA） scanning at 3- month, 9-month, 1-year and every-year after operation showed no stent grafts translocation and bypass graft obstruction. Results The surgical operation and stent grafts implantation were completely successful. Angiography showed 1 case had end leakage and other cases no obvious displacement or end leakage of stent grafts in operation. Blood flow in true lumen of aortic dissection was recovered and all of bypass grafts were unobstructed. No death and severe complications occurred. All patients were followed-up with 3 to 56 months [ （29. 0 ± 10. 2） months], and all patients resumed normal life. Enhanced CT scanning after operation showed 1 case had endoleak and other cases no endoleak, stent grafts translocation and bypass graft obstruction. No signs of brain and limb ischemia were observed. Conclusions To summarize misunderstanding and experience by continuous＇explore feature of hybrid operation for treating disease involving aortic arch, we developed a more reasonable surgical treatment options that can improve the success rate of complex aortic dissection surgery, and ultimately achieve better surgical r

关 键 词：动脉瘤 夹层 外科学 人工血管 支架 主动脉疾病 外科学 

分 类 号：R654.3[医药卫生—外科学]