主动脉弓上分流联合腔内修复治疗主动脉疾病  

The clinical efficacy of supra-arch branches bypass combined with endovascniar aortic repair for aortic diseases

作　　者：龚勇泉[1] 范瑞新[1] 罗建方 于长江[1] 黄文晖[1] 刘媛[1] 范小平[1] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院心外科,广州510080

出　　处：《中华胸心血管外科杂志》2016年第12期723-727,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：广东省科技计划项目（2012A030400056）,广州市科技计划项目（2014Y2-00052）

摘　　要：目的总结主动脉弓上分流联合血管腔内修复治疗主动脉病变的临床效果。方法2012年1月至2015年8月，广东省人民医院采用主动脉弓上分流联合血管腔内修复方法治疗主动脉疾病120例，其中主动脉夹层103例，动脉瘤16例，主动脉穿透性溃疡1例。建立头臂血管间旁路，同期或分期完成经股动脉血管腔内修复手术，术后随访3个月至2年。结果所有患者均手术成功。5例（4．1％，5／120）早期死亡，其中心包压塞2例，夹层逆行撕裂、窒息、呼吸心搏骤停各I例。脑梗塞4例，3例治疗后症状缓解，1例自动出院。随访92例，均无上肢缺血及头晕，CT提示旁路血管通畅，支架血流通畅；内漏6例（Ib型2例，Ⅱ型3例，Ⅲ型1例），术后出现1例，支架远端少量造影剂渗漏3例，术后出现远端夹层、A型夹层1例；无晚期死亡。结论主动脉弓上分流联合血管腔内修复方法微创安全可行，能减少术后并发症。Objective To summarize the effect of supra-arch branches bypass combined with endovascular aortic repair for aortic diseases. Methods From January 2012 to August 2015, 120 cases of thoracic aortic diseases（ aortic dissection 103, aortic aneurysm 16, penetrating aortic ulcer 1 ） received hybrid operation in Guangdong Cardiovascular Institute. Vascular bypass was established among the brachiocephalic arteries, followed by endovascular repair through femoral artery either one-stage or two-stage. Patients were followed up for 3 - 24 months. Results Technical success was achieved among all the patients. Five patients died after the operation（ one patient had retrograde aortic dissection, 2 patients had pericardial tamponade, one patient had apnea, and one patient had respiratory and cardiac arrest. The death rate is 4.1% ）, 4 patients had stroke, among them, symptoms were relieved in three patients, one patient was not cured. Total 92 patients were followed-up and had no symptoms of up-limb ischemia or dizziness. CT scan showed by- pass graft and endovascular stent patency. 6 patients had endoleak（ type I b 2 cases, type IT 3 cases, and type In 1 case）, distal aortic dissection occurred in one patient, three patients had mild contrast agent leakage around the distal endovascular stent, type A aortic dissection occurred in one patient, there were no late stage death. Conclusion Supra- arch branches bypass combined with endovascular aortic repair for treating aortic disease is minimally invasive, safe, and can reduce the incidence of postoperative complications.

关 键 词：主动脉夹层 动脉瘤 杂交技术 血管腔内修复术 

分 类 号：R654.2[医药卫生—外科学]