主动脉缩窄合并降主动脉瘤的外科治疗  

Outcome of surgical repair for aortic coarctation with coexisting descending aortic aneurysm in adult patients

作　　者：鲁亦凡 乔环宇[1] 杨波[1] 赵宏磊 张浩 白涛[1] 薛金熔[1] 刘永民[1] Lu Yifan;Qiao Huanyu;Yang Bo;Zhao Honglei;Zhang Hao;Bai Tao;Xue Jinrong;Liu Yongmin(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院主动脉外科中心一区,北京100029

出　　处：《中华心血管病杂志》2023年第5期469-475,共7页Chinese Journal of Cardiology

基　　金：北京市科委项目(Z191100006619094)。

摘　　要：目的初步评估外科手术治疗主动脉缩窄合并降主动脉瘤的疗效。方法该研究为回顾性队列研究。选取2015年1月至2019年4月就诊于北京安贞医院的主动脉缩窄成年患者。通过主动脉CT血管成像确定主动脉缩窄的诊断,依据降主动脉直径将纳入患者分为合并降主动脉瘤组和未合并降主动脉瘤组。收集入组患者的一般临床资料及手术相关资料,记录术后30 d死亡和并发症发生情况,出院时所有患者均测量上肢收缩压。患者出院后通过门诊、电话随访其生存情况以及再次干预和不良事件发生情况,其中不良事件包括死亡、脑血管事件、短暂性脑缺血发作、心肌梗死、高血压、术后再狭窄、其他心血管相关的干预。结果共纳入107例主动脉缩窄患者,年龄(34.1±15.2)岁,男性68例(63.6%)。其中合并降主动脉瘤组16例,未合并降主动脉瘤组91例。合并降主动脉瘤组中,6例(6/16)采用人工血管转流术,4例(4/16)接受了胸主动脉人工血管置换术,4例(4/16)接受了主动脉根部手术+支架象鼻手术,2例(2/16)接受了胸主动脉腔内修复术。在手术方式的选择上,两组间差异均无统计学意义(P均>0.05)。合并降主动脉瘤组中,术后30 d时1例再次行开胸手术,1例出现下肢不全截瘫,1例死亡;两组术后30 d终点事件发生情况差异均无统计学意义(P均>0.05)。两组患者出院时上肢收缩压较术前均明显降低[合并降主动脉瘤组:(127.3±16.3)mmHg(1 mmHg=0.133 kPa)比(140.9±16.3)mmHg,P=0.030;未合并降主动脉瘤组:(120.7±13.2)mmHg比(151.8±26.3)mmHg,P=0.001]。随访时间为3.5(3.1,4.4)年。合并降主动脉瘤组无新增死亡,无短暂性脑缺血发作、心肌梗死及二次手术病例,1例(1/15)发生脑梗死,10例(10/15)诊断为高血压;两组术后随访期间终点事件发生情况差异均无统计学意义(P均>0.05)。结论在有经验的中心,经过外科手术干预的主动脉缩窄合并降主动脉瘤�Objective To evaluate the efficacy of surgical treatment of aortic coarctation combined with descending aortic aneurysm in adult patients.Methods This is a retrospective cohort study.Adult patients with aortic coarctation who were hospitalized in Beijing Anzhen Hospital from January 2015 to April 2019 were enrolled.The aortic coarctation was diagnosed by aortic CT angiography,and the included patients were divided into the combined descending aortic aneurysm group and the uncomplicated descending aortic aneurysm group based on descending aortic diameter.General clinical data and surgery-related data were collected from the included patients,and death and complications were recorded at 30 days after surgery,and upper limb systolic blood pressure was measured in all patients at discharge.Patients were followed up after discharge by outpatient visit or telephone call for their survival and the occurrence of repeat interventions and adverse events,which included death,cerebrovascular events,transient ischemic attack,myocardial infarction,hypertension,postoperative restenosis,and other cardiovascular-related interventions.Results A total of 107 patients with aortic coarctation aged(34.1±15.2)years were included,and 68(63.6%)were males.There were 16 cases in the combined descending aortic aneurysm group and 91 cases in the uncomplicated descending aortic aneurysm group.In the combined descending aortic aneurysm group,6 cases(6/16)underwent artificial vessel bypass,4 cases(4/16)underwent thoracic aortic artificial vessel replacement,4 cases(4/16)underwent aortic arch replacement+elephant trunk procedure,and 2 cases(2/16)underwent thoracic endovascular aneurysm repair.There was no statistically significant difference between the two groups in the choice of surgical approach(all P>0.05).In the combined descending aortic aneurysm group at 30 days after surgery,one case underwent re-thoracotomy surgery,one case developed incomplete paraplegia of the lower extremity,and one case died;and the differences in the incidence of

关 键 词：主动脉缩窄 降主动脉瘤 手术治疗 

分 类 号：R654.3[医药卫生—外科学]