左锁骨下动脉-左颈总动脉转流术联合支架象鼻术治疗主动脉弓远端病变  

Surgical treatment of distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery

作　　者：齐瑞东 朱俊明 陈雷 里程楠 乔志钰 程力剑 葛翼鹏 胡海鸥 夏瑀 邢晓燕 郑铁 孙立忠 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心脏外科中心北京市主动脉疾病诊疗中心,北京100029

出　　处：《中国胸心血管外科临床杂志》2018年第1期49-53,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家科技支撑计划项目(2015BAI12B03);国家卫生计生委公益性卫生行业科研专项(201402009)

摘　　要：目的评价支架象鼻术联合左锁骨下动脉(LSCA)-左颈总动脉(LCCA)转流术治疗主动脉弓远端病变的近中期临床疗效。方法回顾性分析2009年5月至2015年11月我院14例主动脉弓远端病变行支架象鼻植入联合LSCA-LCCA转流术患者的临床资料,均为男性,平均年龄20~69(52±14)岁。术前合并高血压9例,冠状动脉粥样硬化性心脏病(冠心病)5例,陈旧性脑梗死1例。既往经皮冠状动脉介入治疗1例,Bentall术1例,动脉导管结扎术1例,腹主动脉瘤介入1例。结果无院内死亡。同期手术包括冠状动脉旁路移植术2例,升主动脉成形术1例。呼吸机辅助时间和住ICU时间分别为(21±7)h、(43±19)h。胸骨哆开再固定1例;以支架象鼻为锚定区,胸降主动脉腔内覆膜支架1例。随访期间,1例患者失访,其余患者无死亡,恢复良好。结论采用支架象鼻术联合LSCA-LCCA转流术治疗主动脉弓远端病变,可同期处理主动脉近端病变和封闭主动脉弓远端病变,获得满意的近中期临床效果。Objective To evaluate the short-and middle-term outcomes of surgical treatment for distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery.Methods The clinical data of 14 patients with distal aortic arch lesions undergoing stented elephant trunk procedure with left subclavain artery transposition under hypothermic cardiopulmonary bypass（CPB）with antegrade selective cerebral perfusion from May 2009 to November 2015 in our hospital were retrospectively reviewed.All of them were males with a mean age of 52±14 years ranging from 20 to 69 years.Hypertension was observed in nine patients,coronary artery disease in five and prior cerebral infarction in one.History of percutaneous coronary intervention was noted in one patient,history of Bentall operation in one,ligation of patent ductus arteriosus in one and endovascular aneurysm repair in one.Results There was no hospital death.Concomitant procedures included coronary artery bypass grafting in two patients and plasty of the ascending aorta replacement in one.Mean duration of mechanical ventilation and ICU stay was 21±7 h and 43±19 h,respectively.All patients survived and were discharged.One patient was lost to follow-up and no patient died during the follow-up.Postoperative computed tomography revealed good patency of the anastomotic site between the left subclavian artery and the left common carotid artery.Conclusion Stented elephant trunk procedure with left subclavain artery transposition obtains satisfactory surgical results in patients with distal aortic arch lesions.

关 键 词：主动脉弓远端病变 支架象鼻 左锁骨下动脉-左颈总动脉转流术 

分 类 号：R654.3[医药卫生—外科学]