一站式杂交手术治疗复杂胸腹主动脉疾病  

One-stop hybrid surgery for complex thoracic and abdominal aortic disease

作　　者：易凡 唐飞飞 尚玉强 戴仕林 吴伟 YI Fan;TANG Feifei;SHANG Yuqixing(Department of Cardiac and Great Vascular Surgery,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院心脏大血管外科,430014

出　　处：《临床外科杂志》2021年第7期639-642,共4页Journal of Clinical Surgery

基　　金：湖北省卫健委科研立项资助项目(WJ2019F022)。

摘　　要：目的总结应用Hybrid技术,腹主动脉去分支化联合降主动脉腹主动脉腔内修复术治疗复杂胸腹主动脉疾病的经验及效果.方法2016年10月~2020年10月我院收治胸腹主动脉病变病人10例,其中胸腹主动脉瘤1例,胸腹主动脉夹层9例.根据主动脉疾病累及范围,先行相应累及部位的内脏动脉旁路手术,再一期或二期行主动脉腔内覆膜支架修复.随访3~48个月,中位随访时间24.5个月.结果所有手术均成功完成,其中9例一期腔内修复,1例二期腔内修复.同期手术平均手术时间8.5小时,平均腔内手术时间2.0小时.术后30天无死亡病例,围术期5例急性肾损伤,5例急性肝损伤,3例肠梗阻,1例肠漏.其中肠漏瘘病人术后3个月死亡.至随访结束时,所有病人无内漏、截瘫,随访期间所有旁路血管通畅,无狭窄.结论杂交技术治疗复杂胸腹主动脉病可行,近中期疗效满意,长期效果有待进一步随访.Objective To summarize the experience and results of applying Hybrid technology to treat thoracoabdominal aortic diseases in our hospital.Methods We counted 10 patients with thoracoabdominal aortic lesions admitted to our hospital from October 2016 to October 2020,including one case of thoracoabdominal aortic aneurysm and nine cases of thoracoabdominal aortic dissection.According to the extent of aortic disease involvement,visceral artery bypass surgery at the corresponding involvement site was performed first,followed by endoluminal overlapping stent repair of the aorta in one stage.The follow-up period ranged from 3 to 48 months,with a median follow-up time of 24.5 months.Results All surgeries were successfully completed,including 10 cases of first-stage endovascular repair.The average operating time for the same operation was 8.5 h,and the average endovascular operation time was 2.0 h.There were no fatal cases 30 days after surgery,5 cases of acute kidney injury,5 cases of acute liver injury,3 cases of intestinal obstruction,and 1 case of intestinal fistula in the perioperative period.One of the patients with intestinal fistula died 3 months after surgery.By the end of follow-up,all patients had no endoleaks or paraplegia.All bypass vessels were patent and free of stenosis during the follow-up period.Conclusion The hybridization technique is feasible for the treatment of complex thoracoabdominal aortopathy,with satisfactory near-to mid-term outcomes and long-term results awaiting further follow-up.

关 键 词：杂交手术 胸腹主动脉 主动脉夹层 主动脉瘤 

分 类 号：R654.3[医药卫生—外科学]