杂交技术与“烟囱”技术处理主动脉弓部复杂Stanford B型主动脉夹层的并发症比较  

Comparative complications of hybrid and chimney technique in treatment of complicated aortic arch dissection

作　　者：逯党辉 翟水亭[1] 王国权[1] 张志东[1] 李天晓[2] 梁凯[1] 史帅涛[1] 张克伟[1] 李坤[1] 符晓阳[1] 李卫校[1] 

机构地区：[1]河南省人民医院血管外科,郑州450003 [2]河南省人民医院介入治疗科,郑州450003

出　　处：《中华放射学杂志》2015年第3期213-217,共5页Chinese Journal of Radiology

基　　金：国家临床重点专科建设项目（卫办医政函[2011]873号）

摘　　要：目的 探讨杂交技术与“烟囱”技术处理主动脉弓部病变复杂的Stanford B型主动脉夹层的并发症发生情况.方法 回顾性分析接受血管修复手术治疗的51例主动脉弓部病变复杂的Stanford B型主动脉夹层患者资料,33例（A组）采用杂交技术（胸主动脉腔内覆膜支架修复术联合外科转流术）治疗,18例（B组）采用“烟囱”技术（胸主动脉腔内覆膜支架修复术联合“烟囱”支架植入术）治疗.对比分析2组患者住院及随访期（随访时间≥12个月）并发症的发生情况.计量资料比较采用t检验,计数资料的比较采用x2检验.结果 2组患者手术均成功实施.A组、B组的住院时间分别为（22.0±6.3）、（15.9±3.2）d,差异有统计学意义（t=2.952,P=0.005）.住院期间A组12例出现术后并发症（1例脑梗死、1例逆行性A型夹层、6例肾功能异常、2例术后感染、2例死亡）,B组5例出现术后并发症（3例Ⅰ型内漏、1例脑梗死、1例肾功能异常）,2组患者住院期间手术并发症发生率差异无统计学意义（x2=0.386,P=0.534）.随访时间≥12个月的32例患者中,A组21例,B组11例.A组2例出现并发症（1例为持续存在逆行性A型夹层、1例移植物感染）,B组5例出现并发症（3例持续Ⅰ型内漏、1例脑梗死、1例主动脉覆膜支架短缩移位及烟囱支架近端血栓形成）.随访期B组术后并发症发生率高于A组,差异有统计学意义（x2=5.254,P=0.022）.结论 对外科手术风险高的患者首选烟囱技术,而对于外科手术风险不高的患者首选杂交技术.Objective To evaluate the therapeutic complications of hybrid and chimney techniques in treatment of complicated aortic arch dissection.Methods Fifty-one patients with complicated aortic arch dissection underwent endovascular repairs in our department were retrospectively reviewed,including 33 （group A） with hybrid technique（thoracic endovascular aortic repair stent combined with surgical bypass） and 18 with the chimney technique （thoracic endovascular aortic repair stent combined with chimney stenting）.Complications of the two groups in perioperative and follow-up period（≥12 months） were comparatively analyzed.Enumeration data was comapred using Chi-square test,and measurement data was comapred using t test.Results [nterventional operations of the two groups were successfully carried out.The average lengths of stay in hospital were （22.0±6.3） days for group A and （15.9±3.2） days for group B （t=2.952,P=0.005）.Angiography performed during hospitalization found postoperative complications 36％ （12/33） in group A （1 cerebral infarction,1 retrograde type A dissection,6 abnormal renal functions,2 infections and 2 deaths,and 5/18 in group B （3 type Ⅰ endoleaks,1 cerebral infarction,1 abnormal renal function）.There was no significant difference between two groups（x2=0.386,P=0.534）.The postoperative complications were found 2/21 in group A （1 persistent retrograde type A dissection,1 graft infection） and 5/11 in group B （3 persistent type Ⅰ endoleaks,1 cerebral infarction,1 aortic stent graft short displacement and chimney proximal stent thrombosis） during the follow-up period.The difference was statistical significant in two groups （x2=5.254,P=0.022）.Conclusions Chimney technique was choiced for patients with high surgery risk,while hybrid technique for patients with low surgery risk.

关 键 词：主动脉夹层 放射学 介入性 对比研究 手术后并发症 

分 类 号：R654.3[医药卫生—外科学] R816.2[医药卫生—临床医学]