自制血管分流栓在杂交手术治疗复杂型Stanford B型主动脉夹层中的应用  

Hybrid surgical treatment using self-made intraluminal shunt for complicated Stanford B type aortic dissection

作　　者：陈浩[1] 王志维[1] 夏军[1] 吴红兵[1] 邓宏平[1] 吴智勇[1] 徐鹏[1] 周桢[1] 

机构地区：[1]武汉大学人民医院心血管外科

出　　处：《临床外科杂志》2015年第1期44-47,共4页Journal of Clinical Surgery

摘　　要：目的：总结自制“血管分流栓”在杂交手术治疗复杂型 Stanford B 型主动脉夹层的经验和方法。方法对40例急性复杂型 Stanford B 型主动脉夹层采用杂交手术，采用自制“血管分流栓”保持颈动脉血流重建颈部血管。结果均手术成功，术后无脑部急性缺血及左上肢缺血症状；破口封闭良好，无内漏，旁路血管通畅；2例术后死亡，1例术后3 d 发生 A 型夹层；一过性精神症状6例；左侧血胸1例；随访38例，失访2例，1例于出院后1周死亡。术后1个月、1年复查，无脑缺血及左上肢缺血症状；主动脉 CTA 均示支架无移位和内漏，移植的人工血管通畅。结论杂交手术治疗复杂型 Stanford B 型主动脉夹层安全有效，自制“血管分流栓”能保持颈动脉血流通畅，有效减少脑缺血的发生。Objectives To summarize the experience and methods of hybrid surgical treatment u-sing intraluminal shunt for complicated Stanford B type aortic dissection. Methods A total of 40 patients with complicated acute Stanford type B aortic dissection received hybrid procedures. Cervical arteries were reconstructed by using self-made intraluminal shunt to keep carotid arterial blood circulation. Results All the 40 patients were successfully operated. No patient experienced acute intracranial manifestations and left upper limb ischemia. Proximal crevasse were perfectly closed without endoleak and the vascular bypasses were unobstructed. There were 2 cases of perioperative death. One patient had type A aortic dissection at the 3rd day after operation. Other complications included acute renal failure（1 case）,the left hemothorax （1 case）and temporary psychiatric symptoms（6 cases）. A total of 38 patients were followed up,but 2 of them were lost and one of them died within the 1st week after discharge. Postoperative review at the first month and the first year showed no intracranial manifestations or left upper limb ischemia. Aortic CTA re-view showed good graft patency without stent displacement and endoleak. Conclusion Hybrid procedure is a safe and effective treatment for complicated Stanford type B aortic dissection. Self-made intraluminal shunt can maintain the carotid artery blood flow and reduce the occurrence of cerebral ischemia.

关 键 词：杂交手术 血管分流栓 血管旁路 STANFORD B型夹层 

分 类 号：R654.3[医药卫生—外科学]