胸骨上窝切口复合手术治疗复杂主动脉弓部病变的单中心经验  

Single-center experience of hybrid surgery through suprasternal fossa incision in the treatment of complex aortic arch lesions

作　　者：闵心平 徐鹏[1] 昌金星 王志维[1] 夏军[1] Min Xinping;Xu Peng;Chang Jinxing;Wang Zhiwei;Xia Jun(Department of Cardiovascular Surgery,People's Hospital Affiliated to Wuhan University,Wuhan 430061,China)

机构地区：[1]武汉大学人民医院心血管外科,武汉430061

出　　处：《中国血管外科杂志（电子版）》2020年第4期288-291,301,共5页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探讨胸骨上窝切口血管旁路结合腔内技术在治疗复杂主动脉弓部病变的应用。方法回顾性分析武汉大学人民医院2011年3月至2019年12月经胸骨上窝切口行血管旁路及腔内治疗的52例复杂主动脉弓部病变患者的患者资料,其中主动脉夹层38例,弓部壁间血肿3例,主动脉弓部瘤6例,动脉瘤合并夹层5例,观察淋巴漏、神经损伤、内漏、夹层逆撕、血栓发生等并发症的发生情况。结果手术技术成功率100%,围术期死亡1例(1.9%)。术后随访(24.9±18.9)个月,2例(3.8%)发生血管旁路相关脑梗死,喉返神经损伤率为9.6%(5例),淋巴漏发生率5.8%(3例)。早期Ⅰ型内漏发生率为13.5%(7例),晚期Ⅰ型内漏发生率为5.8%(3例);2例患者术后出现夹层逆撕,均为Z2区患者;1例术后转流血管闭塞。结论经胸骨上窝切口可根据弓部病变及分支血管条件个体化选择转流方式,术后血管通畅率高,但需注意避免淋巴管及喉返神经损伤。Objective To investigate the application of the vascular bypass through suprasternal fossa incision combined with endovascular surgery in the treatment of complex aortic arch lesions.Methods The clinical data of 52 patients with complex aortic arch lesions,who were treated by vascular bypass through suprasternal fossa incision combined with endovascular surgery in People's Hospital Affiliated to Wuhan University from March 2011 to December 2019,were analyzed retrospectively.There were 38 cases with aortic dissection,three with intramural hematoma of arch,six with aortic arch aneurysm and five with dissection aneurysm.The complications such as cerebral infarction,lymphatic leakage,nerve injury,internal leakage,retrograde dissection and thrombosis were observed.Results The surgical technique success rate was 100%,and 1 case(1.9%)died during the perioperative period.The follow-up time was(24.9±18.9)months.Two cases(3.8%)developed vascular bypass-related cerebral infarction.The laryngeal nerve injury recurrent rate was 9.6%(5 cases),and the incidence of lymphatic leakage was 5.8%(3 cases).The incidence of early and late type I endoleak was 13.5%(7 cases)and 5.8%(3 cases),respectively.Two patients(both in Zone 2)occurred dissection retrograde tear after operation.One case had bypass occlusion after operation.Conclusion The way of vascular bypass through suprasternal fossa incision can be performed individually according to the anatomic condition of arch lesion and branch vessels,with a satisfactory postoperative patency rate of bypass vessels.However,the possibility of intraoperative damage to lymphatic ducts and recurrent laryngeal nerve need to be recognized.

关 键 词：胸骨上窝切口 复合手术 主动脉夹层 主动脉瘤 主动脉弓 

分 类 号：R654.3[医药卫生—外科学]