一期不开胸杂交手术治疗累及主动脉弓远端的主动脉溃疡临床分析  

One-stage hybrid strategy without sternotomy for penetrating atherosclerotic aortic ulcer involving distal arch

作　　者：任长伟[1] 孙立忠[1] 黄连军[1] 来永强[1] 许尚栋[1] REN Changwei;SUN Lizhong;HUANG Lianjun;LAI Yongqiang;XU Shangdong(Center for Cardiac Surgery,Beijing Anzhen Hospital of Capital Medical University,Beijing Institute of Heart,Lung and Blood Vascular Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科中心北京市心肺血管疾病研究所,北京100029

出　　处：《中华实用诊断与治疗杂志》2020年第8期837-839,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：北京市属医院科研培育项目(PX2019020)。

摘　　要：目的评估一期不开胸杂交手术治疗累及主动脉弓远端的主动脉溃疡的临床效果。方法 18例因降主动脉溃疡累及主动脉弓远端的患者,行一期杂交手术,转流方式采用右腋动脉-左腋动脉转流和右腋动脉-左腋动脉转流-左侧颈动脉转流,主动脉溃疡部位行支架型人工血管植入术,使用血管塞对左锁骨下动脉开口进行封堵,对左侧颈总动脉近端缝扎。随访3~101个月,观察患者住院期间神经系统并发症、内漏、死亡发生情况及随访期间并发症和死亡发生情况。结果住院期间无死亡病例,内漏2例,下肢动脉血栓形成1例,未出现肾功能衰竭和截瘫病例。随访期间死亡2例,其中1例死于脑出血,1例猝死;2例患者股动脉吻合口假性动脉瘤形成。结论一期杂交手术治疗累及远端主动脉弓的降主动脉溃疡近期效果满意,溃疡两端主动脉直径未明显扩张,选择无梁渐细覆膜支架更适合该类患者。Objective To investigate the clinical results of one-stage hybrid strategy without sternotomy for penetrating atherosclerotic aortic ulcer involving distal arch. Methods Eighteen patients with penetrating atherosclerotic aortic ulcer involving distal arch underwent hybrid procedure, applying right axillary artery-left axillary artery bypass and right axillary artery-left axillary artery bypass-left carotid artery bypass. Stent graft was implanted at the aortic ulcer, plugs were implanted into the proximal part of the left subclavian arteries, and the proximal part of left common carotid artery was ligated. The neural complications, endoleak and mortality were observed during hospitalization and in 3-to 101-month follow-up survey. Results During hospitalization, endoleak was found in two patients, lower extremity artery thrombosis occurred in one patient, while no death, renal failure or paraplegia occurred. During the follow-up period, femoral artery anastomoses pseudoaneurysm was found in two patients, and two patients died in which one patient died of cerebral hemorrhage, and the other died suddenly. Conclusion One-stage hybrid procedure can achieve a satisfactory result for penetrating atherosclerotic aortic ulcer involving distal arch. Based on the fact that the diameter of the aorta at both ends of the ulcer is not significantly expanded, the stent-graft with tapered design is more suitable for the patients with aortic ulcer.

关 键 词：主动脉溃疡 一期杂交手术 覆膜支架 

分 类 号：R654.3[医药卫生—外科学]