外科辅助原位针刺开窗技术治疗复杂主动脉弓部病变中期结果  

Mid-term results of surgery-assisted in-situ needle fenestration technique in complicated aortic arch lesion

作　　者：闫盛[1] 刁永鹏[2] 陈作观 吴志远 阎军 刘龙 王世材 李拥军[2] 董红霖[1] Yan Sheng;Diao Yongpeng;Chen Zuoguan;Wu Zhiyuan;Yan Jun;Liu Long;Wang Shicai;Li Yongjun;Dong Honglin(Department of Vascular Surgery,The Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Vascular Surgery,Beijing Hospital,Beijing 100730,China;Department of Vascular Surgery,Taiyuan Central Hospital,Taiyuan 030009,China)

机构地区：[1]山西医科大学第二医院血管外科,太原030001 [2]北京医院血管外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [3]太原市中心医院血管外科,太原030009

出　　处：《中华血管外科杂志》2021年第2期93-98,共6页Chinese Journal of Vascular Surgery

摘　　要：目的评估原位针刺开窗技术治疗复杂主动脉弓部病变的中期疗效。方法回顾性分析2017年10月至2019年9月应用原位针刺开窗技术治疗的13例主动脉夹层患者的临床资料。其中男性1例,女性2例;A型夹层5例,B型夹层8例。结果13例患者均采用c-TAG主动脉覆膜支架进行原位开窗,其中8例患者行弓上二分支重建,5例行弓上三分支重建,技术成功率为100%(13/13)。1例患者术后4个月突发脑出血死亡,其余12例患者获得随访,随访时间(23.3±0.7)个月;术后再发夹层发生率为15.4%(2/13),其中1例于术后6个月出现逆撕,行升主动脉置换术;1例于术后1个月出现颈动脉夹层,无不适表现,未做特殊处理。结论需重建多分支的复杂主动脉弓部病变,经颈部切口原位开窗技术进行重建可以取得良好的中期效果。Objective To evaluate the mid-term results of surgery-assisted in-situ needle fenestration technique in complicated aortic arch lesion.Methods The clinical data of 13 patients(11 males and 2 females)with complicated aortic dissection(AD)treated with surgery-assisted in-situ needle fenestration technique from October 2017 to September 2019 were retrospectively analyzed.There were type A AD in 5 cases and type B in 8 cases.Results In-situ fenestration with c-TAG aortic covered stent was performed on all the 13 patients,among which three supra-arch branches were reconstructed in 8 cases and two supra-arch branches were reconstructed in 5 cases.The technical success rate was 100%(13/13).One patient died of a sudden cerebral hemorrhage 4 months after surgery while the remaining 12 patients were followed up for(23.3±0.7)months.The incidence rate of recurrent postoperative AD was 15.4%(2/13).One patient received ascending aortic replacement due to retrograde AD at 6-month postoperatively.Another patient suffering from cervical artery dissection at the first postoperative month did not receive special treatment because of no discomfort.Conclusion For complicated aortic arch lesion requiring reconstruction of multiple branches,surgery-assisted in-situ needle fenestration technique showed promising mid-term results.

关 键 词：主动脉夹层 主动脉弓部疾病 覆膜支架 原位开窗 

分 类 号：R654.3[医药卫生—外科学]