预开窗与血管转流术治疗累及左锁骨下动脉B型主动脉夹层的疗效比较  

Effectiveness of in vitro fenestration versus bypass surgery for type B aortic dissection involving the left subclavian artery

作　　者：洪昊[1] 刘小斌[1] 杜心灵[1] 蒋雄刚[1] 吴龙[1] 董念国[1] HONG Hao;LIU Xiaobin;DU Xinling;JIANG Xionggang;WU Long;DONG Nianguo(Department of Cardiovascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院心脏大血管外科,武汉430022

出　　处：《中国胸心血管外科临床杂志》2021年第7期788-791,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金面上项目(81873502)。

摘　　要：目的分析应用胸主动脉夹层腔内修复术治疗累及左锁骨下动脉的B型主动脉夹层过程中,分别采取预开窗和血管转流技术重建左锁骨下动脉的疗效。方法回顾性分析2017年1月至2020年10月我中心收治的累及左锁骨下动脉的B型主动脉夹层53例患者的临床资料。其中23例行预开窗+胸主动脉夹层腔内修复术,为预开窗组:男18例、女5例,年龄(53.6±5.3)岁;30例行左颈总动脉-左锁骨下动脉转流+胸主动脉夹层腔内修复术,为转流组:男24例、女6例,年龄(51.8±3.8)岁。比较两组疗效和安全性。结果两组手术成功率均为100.0%,均无术后30 d和随访死亡。两组术后即刻、1年随访均无内漏。预开窗组手术时间、住院费用短于或少于转流组(P<0.05)。预开窗组术后左上肢血压降低幅度大于转流组(P<0.05)。两组术后均无左上肢缺血、头晕和声音嘶哑症状。结论两种左锁骨下动脉重建方式安全、有效,预开窗术可以减少手术创伤和费用,血管转流术可以为左锁骨下动脉提供更好的前向血流。Objective To analyze the effectiveness of in vitro fenestration versus bypass surgery techniques in the treatment of type B aortic dissection involving the left subclavian artery by thoracic endovascular aortic repair(TEVAR).Methods Among the 53 patients with type B aortic dissection involving the left subclavian artery admitted to our center from January 2017 to October 2020,23 underwent in vitro fenestration+TEVAR(a fenestration group with 18 males and5 females aged 53.6±5.3 years),and 30 patients underwent left common carotid artery-left subclavian artery bypass+TEVAR(a bypass group with 24 males and 6 females aged 51.8±3.8 years).The effectiveness and safety between the two groups were compared.Results The surgical success rate was 100.0%in both groups.And there was no death within postoperative 30 days and during the follow-up.There was no endoleak immediately postoperatively and during 1-year follow-up in the two groups.The operation time and hospitalization expenses in the fenestration group was less or shorter than those in the bypass group(P<0.05).The reduction in blood pressure of the left upper limb in the fenestration group was greater than that in the bypass group(P<0.05).There was no symptom of left upper limb ischemia,dizziness or hoarseness in both groups.Conclusion The two methods of reconstruction of the left subclavian artery are safe and effective.In vitro fenestration can reduce surgical trauma and costs,and bypass surgery can provide better forward blood flow for the left subclavian artery.

关 键 词：左锁骨下动脉 B型主动脉夹层 预开窗 血管转流术 

分 类 号：R654.3[医药卫生—外科学]