开窗技术在主动脉弓部病变治疗中的应用  

Application of fenestration technique in the treatment of aortic arch disease

作　　者：王韧[1] 翁国星[1] 陈智群[1] 谢琦[1] 陈远翔[1] 窦志[1] 陈海宇[1] 蔡文龙[1] Wang Ren;Weng Guoxing;Chen Zhiqun;Xie Qi;Chen Yuanxiang;Dou Zhi;Chen Haiyu;Cai Wenlong(Department of Cardiovascular Surgery, Provincial Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, China)

机构地区：[1]福建医科大学省立临床学院福建省立医院心外科,福州350001

出　　处：《中华胸心血管外科杂志》2019年第5期285-289,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：福建省立医院高水平医院建设科研基金(2017LHJJ01).

摘　　要：目的探讨开窗技术在主动脉弓部病变中的应用。方法13例主动脉弓病变累及部分支血管的患者,主动脉弓部瘤5例,其中主动脉弓部溃疡伴壁间血肿4例,Ⅲ型主动脉夹层3例,主动脉覆膜支架置入术后Ⅰ型内漏1例。均采用开窗技术重建主动脉弓部分支。8例采用了体外开窗技术,5例采用了原位开窗技术。重建左锁骨下动脉9例、左颈总动脉和左锁骨下动脉3例、同时重建弓部三分支血管1例。结果13例手术均成功,无内漏,重建血管通畅,无狭窄、漏血。无严重并发症发生和围手术期死亡。随访期10~22个月,随访期无重要血管相关并发症发生,无死亡。结论开窗技术为我们解决主动脉弓部病变提供了一种新的方法,对合适的患者可取得满意的近期效果,远期效果有待进一步随访。Objective Assessment of fenestration in the aortic arch disease. Methods 13 patients with aortic arch disease underwent fenestration operation to reconstruct affiliated vessels, aortic arch aneurysm in 5 patients, aortic anch ulcer in 4,Ⅲ type aortic dissection in 3 and Ⅰ type leakage after aortic stent graft in 1 patient. All patieuts were divided into 2 groups. 8 patients in pre-fenestration group, 5 patients in in-situ fenestration group. Only left subclavian artery was rebuilded in 9 patients, both left carotid common artery and left subclavian artery were rebuilded in 3 patients, all three affiliated vessels of arch were rebuilded in 1 patient. Results Branch vessels of aortic arch were successfully rebuilded in all 13 patients. There were no endoleak, stenosis of branch vessels, graft diaplacement or deaths peri-operative period. During follow-up, no postoperative complications occurred and all target vessels remained patent. No fenestration related endoleaks were observed. Conclusion Fenestration may be a viable alternative for patients with aortic arch disease.

关 键 词：开窗技术 主动脉疾病 

分 类 号：R654.3[医药卫生—外科学]