体外转流联合多种原位开窗技术在主动脉弓部疾病腔内修复的应用  

Application of Extracorporeal Bypass Combined With Multiple In-situ Fenestration Technique for Intracavitary Repair of Aortic Arch Diseases

作　　者：张科[1] 侯培勇[1] 李祺熠[1] 魏立春[1] 许太福 苏奕明 Zhang Ke;Hou Peiyong;Li Qiyi(Department of Vascular Surgery,Liuzhou Workers’Hospital,Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou 545005,China)

机构地区：[1]广西医科大学第四附属医院柳州市工人医院血管外科

出　　处：《中国微创外科杂志》2019年第10期874-877,881,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：柳州市科技重点研发计划(2018BJ10508)

摘　　要：目的探讨体外转流联合激光或穿刺针腔内原位开窗技术治疗累及主动脉弓部疾病的近期疗效和安全性。方法回顾性分析2016年12月~2018年12月20例累及主动脉弓上分支动脉的主动脉瘤(夹层)资料,应用体外转流联合激光或穿刺针腔内原位开窗技术进行腔内修复。结果19例成功完成原位开窗,1例术中死亡。应用体外转流10例。9例左锁骨下动脉开窗,其中1例因左锁骨下动脉弯曲角度过大未能完成原位开窗,置入烟囱支架;4例左锁骨下动脉+左颈总动脉双开窗,6例左锁骨下动脉+头臂干+左颈总动脉三开窗。围手术期死亡2例,其中1例术中因升主动脉破裂死亡,1例术后3天因大面积脑梗死死亡。术后早期并发症2例(1例暂时性神经功能障碍,1例肺部感染),均治愈出院。18例随访时间6~30个月,(18±3)月,主动脉CTA显示主动脉弓部病变部位均隔绝良好,无内漏,开窗血管通畅。结论对累及主动脉弓部疾病,应用体外转流联合激光或穿刺针腔内原位开窗技术行腔内修复术微创、有效,但应术前全面评估病情,掌握好适应证。Objective To investigate the short-term efficacy and safety of in vitro shunt combined with laser or puncture needle in situ fenestration in the treatment of aortic arch disease.Methods A retrospective analysis was performed on the data of 20 patients with aortic aneurysm/dissection involving the superior branch of the aortic arch who underwent intracavitary repair with extracorporeal bypass combined with laser or puncture needle in situ fenestration technique in our department from December 2016 to December 2018.Results The in-situ fenestration was successfully completed in 19 cases and 1 case died intraoperatively.There were 10 cases of in vitro bypass.In 9 cases,the left subclavian artery was windowed,among which 1 case failed to complete in situ fenestration due to the excessive bending angle of the left subclavian artery,and a chimney stent was implanted.Four cases received double fenestration of left subclavian artery and left common carotid artery,and 6 cases had triple fenestration of left subclavian artery,brachiocephalic artery and left common carotid artery.There were 2 cases of perioperative death,including 1 patient who died of ascending aorta rupture during operation and 1 patient who died of massive cerebral infarction 3 days after operation.Two cases of early postoperative complications(1 case of temporary neurological dysfunction and 1 case of pulmonary infection)were cured and discharged.The follow-up time of the 18 cases was 6-30 months,with an average of(18±3)months.Enhanced aortic CT showed that the lesion sites in the aortic arch were well isolated,without internal leakage,and the fenestration vessels were smooth.Conclusions For aortic diseases involving the arch,in vitro bypass combined with laser or puncture needle in situ fenestration technique is minimally invasive and effective.It is relatively safe to fully evaluate the patient’s condition and follow the indications before operation.

关 键 词：主动脉弓部疾病 腔内修复 体外转流 原位开窗 激光 穿刺针 

分 类 号：R65[医药卫生—外科学]