一期杂交手术治疗主动脉弓部疾病的远期结果  

The long-term outcomes of one-stage hybrid procedure for aortic arch pathologies

作　　者：陈宏[1] 陈苏伟 钟永亮[1] 乔志钰[1] 里程楠[1] 葛翼鹏[1] 齐瑞东[1] 胡海瓯[1] 朱俊明[1] Chen Hong;Chen Suwei;Zhong Yongliang;Qiao Zhiyu;Li Chengnan;Ge Yipeng;Qi Ruidong;Hu Haiou;Zhu Junming(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Aortic Disease Center,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,北京市心肺血管疾病研究所,北京100029

出　　处：《中华胸心血管外科杂志》2022年第2期75-79,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的回顾分析我院接受杂交手术(Hybrid arch repair,HAR)治疗主动脉弓部疾病的远期预后结果。方法2009年1月至2018年1月,共87例患者因主动脉弓部疾病于北京安贞医院接受HAR治疗,男76例,女11例;年龄(62.2±9.6)岁。2例为0区,46例为1区,39例为2区。结果5例(5.7%)手术死亡。中位随访46.2个月。远期随访死亡13例(19.1%)。1、3、5、10年总生存率为88.4%、83.3%、83.3%、49.8%。多因素Cox比例风险分析结果显示,卒中(HR=20.626,95%CI:2.698~157.685,P=0.004)是患者术后早期死亡的危险因素。而卒中(HR=16.234,95%CI:4.103~64.229,P<0.001)、脊髓损伤(HR=11.060,95%CI:2.150~56.893,P=0.004)为患者术后远期死亡的危险因素。结论在严格掌握手术适应证的前提下,HAR可以作为不适合接受开放手术的替代治疗方式,但应该严格筛选合适的患者。未来应该建立和完善针对HAR手术的风险评估系统和统一适应证。Objective To analyze the long-term outcomes of hybrid arch repair(HAR)treating aortic arch pathologies.Methods Between January 2009 and January 2018,87 consecutive patients underwent HAR for aortic arch pathologies at Beijing Anzhen Hospital.76 were males.2 cases were in zone 0,46 cases were in zone 1,and 39 cases were in zone 2.The zones of the aortic arch were defined following the Ishimaru classification.Results Five(5.7%)operative death occurred.13 patients(19.1%)died during the follow-up.The overall survival rate was 88.4%,83.3%,83.3%,49.8%at 1,3,5,10 year,respectively.Multivariate Cox proportional risk analysis showed that stroke(HR=20.626,95%CI:2.698-157.685,P=0.004)was an independent risk factor for short-term death.Stroke(HR=16.234,95%CI:4.103-64.229,P<0.001)and spinal cord infury(HR=11.060,95%CI:2.150-56.893,P=0.004)were independent risk factors for long-term death.Conclusion In conclusion,HAR could be an alternative procedure for the patients that are not suitable for open repair under the premise of strict control of indications.In the future,the risk assessment system and uniform operational indications for HAR should be further established.

关 键 词：杂交手术 主动脉弓 胸主动脉腔内修复术 旁路移植 远期预后 

分 类 号：R654.3[医药卫生—外科学]