腔内治疗应用于主动脉弓部病变患者的临床疗效  

Clinical effect of endovascular treatment in patients with aortic arch lesions

作　　者：任明明[1] 韩振[1] 冯钢[1] 黄磊[1] 吴永前[1] 许志锋[1] 欧阳春[1] REN Ming-ming;HAN Zhen;FENG Gang;HUANG Lei;WU Yong-qian;XU Zhi-feng;OUYANG Chun(Department of Cardiovascular Surgery,Peking University Shenzhen Hospital,Shenzhen Guangdong 518000,China)

机构地区：[1]北京大学深圳医院心血管外科,广东深圳518000

出　　处：《局解手术学杂志》2021年第9期778-783,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：广东省哲学社会科学“十二五”规划项目(2017B060500027)。

摘　　要：目的探讨腔内治疗应用于主动脉弓部病变患者的临床效果。方法选取80例主动脉弓部病变患者为研究对象,患者均采用主动脉腔内修复治疗。记录患者手术时间、术中出血量、呼吸机辅助时间、ICU时间、术后运动恢复时间、术后饮食恢复时间、住院时间等指标,记录患者手术效果。术中观察旁路人工血管或者覆膜支架的应用效果;术后随访36个月,通过CT血管造影(CTA)评价主动脉支架和烟囱支架表现、是否出现内漏、夹层假腔或者动脉瘤腔血管栓塞情况。记录患者治疗前后脑梗死、暂时性神经功能障碍、脊髓损伤、肺部感染、肾功能不全透析情况。评价患者治疗前后自我管理能力及生存质量。结果所有患者手术均取得技术性成功,覆膜支架平均直径(34.5±2.5)mm;手术时间为(1.51±1.00)h,术中出血量为(150.54±90.01)mL,呼吸机辅助时间(23.01±1.58)h,ICU时间(74.30±6.71)h,术后运动恢复时间为(49.45±21.10)h,术后饮食恢复时间为(25.18±11.23)h,住院时间为(12.09±4.05)d;15例患者出现内漏,术后仅3例患者出现重度不良事件。治疗期间升主动脉造影表明主动脉覆膜支架位置固定精准;术后影像学检查显示,旁路人工血管和烟囱支架、覆膜支架在位良好,应用效果好。与治疗前比较,治疗后患者脑梗死、暂时性神经功能障碍、脊髓损伤、肺部感染、肾功能不全透析等症状均改善(P<0.05)。与治疗前相比,治疗后患者自我管理能力及生活质量评分提高(P<0.05)。结论腔内治疗应用于主动脉弓部病变患者的临床疗效显著,可有效避免术后不良事件的发生,促进患者康复,提高生存质量。Objective To investigate the clinical outcome of endovascular treatment in patients with aortic arch lesions.Methods A total of 80 patients with aortic arch lesions who were treated with aortic endovascular repair were selected.The operation time,intraoperative blood loss,ventilator assistance time,ICU time,postoperative exercise recovery time,postoperative diet recovery time,hospital stay were recorded,and the operation efficacy was recorded.The effect of bypass artificial blood vessel or covered stents during operation was observed;patients were followed up for 36 months after operation,the performance of aortic stent and chimney stent,whether to form endoleak,vascular embolism in aortic dissection false lumen or aneurysm lumen were evaluated through CT angiography(CTA).The cerebral infarction,temporary neurological dysfunction,spinal cord injury,lung infection,and renal insufficiency and dialysis before and after treatment were recorded.The self-management ability and the quality of life before and after treatment were evaluated.Results The operations for all patients were technically successful.The mean diameter of the covered stents was(34.5±2.5)mm;the operation time was(1.51±1.00)hours,the intraoperative blood loss was(150.54±90.01)mL,the ventilator assistance time was(23.01±1.58)hours,ICU time was pared with those before treatment(P<0.05).After treatment,the scores of patients’self-management and quality of life were significantly improved compared with those before treatment(P<0.05).Conclusion Endovascular treatment has a significant clinical effect in the treatment of patients with aortic arch lesions,which can effectively avoid the occurrence of postoperative adverse events,promote the recovery and improve the quality of life of patients.

关 键 词：腔内治疗 主动脉弓部病变 主动脉腔内修复术 烟囱技术 弓部动脉瘤 Stanford B型夹层 穿透性溃疡 主动脉食管瘘 

分 类 号：R654.3[医药卫生—外科学]