升主动脉-颈内动脉、锁骨下动脉人工血管旁路术治疗头臂型大动脉炎  

Ascending aorta to internal carotid and subclavian artery bypass for Takayasu's arteritis involving cerebral trunk

作　　者：齐一侠[1] 谷涌泉[1] 俞恒锡[1] 崔世军[1] 郭连瑞[1] 

机构地区：[1]首都医科大学宣武医院血管外科,北京100053

出　　处：《中日友好医院学报》2016年第4期213-216,共4页Journal of China-Japan Friendship Hospital

摘　　要：目的：探讨升主动脉-颈内动脉、锁骨下动脉人工血管旁路术治疗大动脉炎的疗效。方法：回顾分析2008年12月~2014年12月间14例大动脉炎累及颈内动脉、锁骨下动脉的患者的临床资料。所有患者采用动脉旁路术,其中升主动脉-单腋动脉、单颈内动脉搭桥9例,升主动脉-双腋动脉搭桥4例,升主动脉-双腋动脉、单颈内搭桥1例。结果：升主动脉人工血管旁路术可明显改善头臂型大动脉炎所导致的严重脑缺血及上肢缺血症状。14例手术患者手术成功100%,全组无围手术期死亡,均顺利出院,症状均得到很好的缓解。1例在术后5个月突发脑出血死亡,11例患者获得15~115个月的随诊：1例在术后6个月发生人工血管闭塞（升主动脉-腋动脉）,1例术后66个月人工血管闭塞（升主动脉-左腋、左颈内动脉）,1例在79个月时右颈内动脉吻合口处瘤状扩张。结论：对于大动脉炎累及颈内动脉、锁骨下动脉的患者,升主动脉-颈内动脉、锁骨下动脉人工血管旁路术可以有效改善动脉血流。Objective：To investigate the efficacy of ascending aorta to internal carotid and subclavian artery bypass for Takayasu＇s Arteritis（TA）.Methods：Fourteen TA cases involving internal carotid and subclavian arteries from 2008.12 to 2014.12 were analyzed.All patients received arterial bypass,including 9 ascending aorta to unilateral axillary and internal carotid arteries,4 ascending aorta to bilateral axillary arteries,and 1 ascending aorta to bilateral axillary and unilateral internal carotid arteries bypass.Results：Artificial graft bypass from ascending aorta successfully resolve the severe cerebral ischemia and upper limb ischemia caused by cerebral trunk TA.All patients were discharged smoothly and their symptoms were relieved satisfactorily.The patients were followed up 5 to 115 months.One patient died from cerebral hemorrhage 5 months after surgery.Artificial grafts were occluded in two patients,i.e.,one with ascending aorta to unilateral axillary artery bypass6 months after surgery and another with ascending aorta to left axillary and left carotid arteries bypass 66 months after surgery.One patient presented aneurysmal ectasia at anastomotic site 79 months after surgery.Conclusion：For TA patients involving internal carotid and subclavian arteries,artificial graft bypass from ascending aorta to internal carotid and/or axillary arteries is safe and effective for improving blood flow of brain and upper limbs.

关 键 词：头臂型大动脉炎 动脉旁路术 

分 类 号：R654.3[医药卫生—外科学]