锁骨下动脉-颈总动脉转位术在不能介入治疗的锁骨下动脉近端闭塞患者中的应用  

Application of subclavian-carotid transposition to patients with proximal subclavian artery occlusion unable to be intervened

作　　者：顾沅芮 孙阳雪 田晨[1] 罗明尧[1] 方坤[1] 舒畅[1] 欧阳晨曦[1] GU Yuanrui;SUN Yangxue;TIAN Chen;LUO Mingyao;FANG Kun;SHU Chang;OUYANG Chenxi(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院血管外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2020年第9期1005-1009,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划项目(2018YFC1105501);北京市科技计划项目(Z191100007619039)。

摘　　要：目的探索锁骨下动脉-颈总动脉转位术(subclavian-carotid transposition,SCT)在不能介入治疗(介入治疗失败、先天畸形、患者不愿行介入治疗)的锁骨下动脉近端闭塞患者中的治疗效果。方法回顾性分析2016年5月至2018年12月采用SCT治疗的19例不能介入治疗的锁骨下动脉近端闭塞患者的临床资料,其中男14例、女5例,平均年龄(54.05±17.34)岁。分析SCT在锁骨下动脉近端闭塞治疗中的优劣势。结果 19例患者手术均成功。术后患侧锁骨下动脉近端的狭窄程度由100.0%±0.0%下降至12.7%±10.1%,健侧与患侧的平均压差由(11.95±10.60)mm Hg下降至(0.89±5.75)mm Hg(P<0.01)。所有患者术后症状均有改善,7例(36.8%)患者发生周围神经损伤。本院同期支架植入治疗平均住院费用比SCT多支出3 392.12元(除去偏差较大的患者,则多支出4 812.01元)。随访时间为1~3年,7例周围神经损伤患者中6例均恢复正常,仅1例(5.3%)未恢复,术后1年和3年通畅率均为100.0%,未出现围术期死亡、卒中、术后再次治疗等。结论对于不能介入治疗的锁骨下动脉闭塞患者,SCT是一个理想的治疗方案。Objective To investigate the efficacy of subclavian-carotid transposition(SCT) in treating patients with proximal subclavian artery occlusive diseases who were unable to be intervened,such as failure of intervention,congenital malformation and unwillingness to intervention.Methods A retrospective review of 19 patients with proximal subclavian artery occlusion who underwent SCT from May 2016 to December 2018 was done.There were 14 males and 5 females with an average age of 54.05±17.34 years.The advantages and disadvantages of SCT in the treatment of proximal subclavian artery occlusion were analyzed.Results All patients achieved immediate remission of symptoms after surgery.The stenosis degree of the proximal subclavian artery decreased from 100.0%±0.0% to 12.7%±10.1% after surgery.The average blood pressure difference between the unaffected side and the affected side decreased from11.95±10.60 mm Hg to 0.89±5.75 mm Hg(P<0.01).Peripheral nerve injury occurred in 7(36.8%) patients.The in-patient cost of subclavian artery occlusion patients who received subclavian artery interventional therapy in our hospital during the corresponding period was 3 392.12 yuan higher than that of the SCT group in average(if eliminating the patients whose cost was far from the average value,the cost of interventional therapy was 4 812.01 yuan higher than that of the SCT group in average).During 1-3 years’ follow-up,6 patients with neurological complication relieved.One-and threeyear patency rates were 100.0%.No perioperative stroke,death or re-operation happened.Conclusion SCT is an ideal process for the patients with subclavian artery occlusion who cannot accept subclavian artery interventional therapy.

关 键 词：锁骨下动脉-颈总动脉转位术 锁骨下动脉闭塞 窃血综合征 介入治疗 

分 类 号：R654.4[医药卫生—外科学]