复合手术治疗Stanford B型胸主动脉夹层  

Hybrid operation for the treatment of Stanford type B aortic dissection

作　　者：逯党辉 翟水亭[2] 李天晓[3] 王国权[2] 张志东[2] 朱绍成[1] 梁凯[2] 张克伟[2] 李坤[2] 符晓阳[2] 李卫校[2] 

机构地区：[1]新乡医学院,河南新乡453003 [2]郑州大学人民医院血管外科 [3]郑州大学人民医院介入科

出　　处：《介入放射学杂志》2015年第10期897-901,共5页Journal of Interventional Radiology

基　　金：国家临床重点专科建设项目(卫办医政2011-873号)

摘　　要：目的探讨复合手术技术治疗主动脉弓部病变复杂的Stanford B型胸主动脉夹层的临床疗效。方法2011年1月至2013年12月采用复合手术治疗主动脉弓部病变复杂的StanfordB型胸主动脉夹层患者33例，其中男28例，女5例，平均年龄（50±12）岁。分析围手术期及随访期（≥12个月）临床疗效及并发症发生情况。结果33例手术均顺利，技术成功率为100％，无术中死亡病例，平均住院时间22d。术后随访3～34个月29例，失访4例，随访率87．9％；21例随访≥12个月。术后造影无I型内漏发生，并发肺部感染1例、脑卒中1例、可逆性肾功能异常6例、逆行性A型夹层1例，无截瘫发生。术后住院期间死亡2例，病死率6．06％。随访期发生移植物感染1例、逆行性A型夹层持续存在1例，无死亡病例。结论复合手术治疗Stanford B型胸主动脉夹层围手术期及随访期并发症发生率低，具有良好的安全性与可行性，但术后部分严重并发症仍不可忽视，远期疗效尚需大样本系统性长期随访观察。Objective To evaluate the clinical effect of hybrid operation in treating Stanford type B aortic dissection. Methods During the period from January 2011 to December 2013, hybrid operation was performed in 33 patients with complex Stanford type B aortic arch dissection. The patients included 28 males and 5 females with a average age of （50±12） years. The clinical effect and the complications, occurring in perioperative period and in 24-month follow-up period, were analyzed. Results The operation was successfully accomplished in all 33 patients, with a technical success rate of 100%. The average hospitali- zation time was 20 days. After the operation, 29 cases were followed up for 3-34 months and 4 cases were lost to follow up, the following-up rate was 87.9%. In 21 cases, the following-up time was over 12 months. Postoperative angiography showed that there was no type I endoleak; complications included pulmonary infection （n=l）, strokes （n=l）, reversible abnormal renal function （n=6） and retrograde aortic arch dissection （n=l）. No paraplegia occurred. During hospitalization time, two cases died, the mortality was 6.06%. During the following-up time, graft infection occurred in one case and continued presence of retrograde aortic arch dissection was observed in one case. Conclusion The complication occurrence after hybrid operation for Stanford type B aortic dissections is low. The hybrid technique is very safe and feasible, but several serious postoperative complications should not be ignored. The long-term effectiveness needs to be further clarified by systemic and large sample studies.

关 键 词：主动脉夹层 复合手术 并发症 

分 类 号：R654.3[医药卫生—外科学]