南疆地区某三级医院对Stanford B型主动脉夹层介入治疗及杂交手术的疗效分析  

Efficacy of Interventional and Hybrid Surgery for Patients with Stanford Type B Aortic Dissection in A Tertiary Hospital in the Southern Xinjiang Region

作　　者：阿地力江·阿布都热苏力[1] 陈泽锐 亚森江·麦麦图尔迪 阿曼江·艾尔肯 ADiLiJiang·Abuduresuli;CHEN Zerui;YaSenJiang·Maimaituerdi;AManJiang·Aierken(Department of Cardiac and Major Vascular Surgery,The First People′s Hospital of Kashi,Xinjiang Kashi 844000,China;De-partment of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou 510080,China)

机构地区：[1]新疆喀什地区第一人民医院心脏大血管外科,新疆喀什844000 [2]广东省心血管病研究所心外科南方医科大学附属广东省人民医院(广东省医学科学院),广州510000

出　　处：《岭南心血管病杂志》2023年第3期273-278,共6页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金(项目编号:A2020011);广东省援疆农村科技(特派员)项目(项目编号:KTPYJ2021023)。

摘　　要：目的分析并总结Stanford B型主动脉夹层(aortic dissection,AD)介入治疗及杂交手术的疗效。方法回顾性分析2016年9月至2021年5月在新疆喀什地区第一人民医院进行Stanford B型AD介入治疗及杂交手术的107例患者的临床资料。主动脉腔内隔绝术102例、同期行主动脉弓上分流术5例。限期手术96例、急诊手术11例。完全盖住左锁骨下动脉为19例。同期胸主动脉置入两个覆膜支架为13例、同期胸腹主动脉置入覆膜支架3例。全组患者在全身麻醉下股动脉切开进行。患者行常规桡动脉有创血压检测,根据其实际病情左侧肱动脉穿刺或不穿刺。通过当时造影结果、并发症和术后随访结果等评估患者的疗效及安全性。结果AD介入治疗及杂交手术成功率为100%,术中支架释放后发生Ⅰ型漏11例(10.28%),左颈总动脉误闭1例(0.93%),术中股动脉层次破坏2例(1.87%),术后截瘫1例(0.93%),术后死亡1例(0.93%)。术后随访3~48个月,随访期间死亡3例(3.75%),血压控制欠佳7例(8.75%),新发夹层2例(2.50%),胸腔积液4例(5.0%),有临床症状13例(16.25%),术后复查主动脉计算机断层扫描血管造影(CTA)发现内漏1例(1.25%),未发现支架形态变异、血栓形成。结论Stanford B型AD介入治疗及杂交手术具有疗效确切、并发症少、安全性高、介入技术不复杂等优点,经过云平台的技术交流在线指定方案,在偏远的地区级医院开展该项技术可明显降低当地AD患者的病死率、改善其预后。Objectives To analyze and summarize the efficacy of interventional and hybrid surgery for patients with Stanford type B aortic dissection.Methods The clinical data of 107 patients who underwent interventional and hybrid surgery for Stanford type B aortic dissection in The First People′s Hospital of Kashi from September 2016 to May 2021 were retrospectively analyzed.There were 102 cases of aortic endovascular isolation and 5 cases of supra-aortic shunt at the same time.There were 96 cases of limited operation and 11 cases of emergency operation.The left subclavian artery was completely covered in 19 cases.Two stent-grafts were placed in the thoracic aorta during the same period in 13 cases,and stent-grafts were placed in the thoracic and abdominal aorta in 3 cases during the same period.The whole group underwent femoral arteriotomy under general anesthesia.Routine radial artery invasive blood pressure detection,according to the actual condition of the left brachial artery puncture or no puncture.The efficacy and safety were evaluated by the angiographic results,complications and postoperative follow-up results.Results The success rate of aortic dissection intervention and hybrid surgery was 100%.There were 11 cases(10.28%)of type I leakage after stent release,1 case(0.93%)of left common carotid artery by mistake,and 2 cases(1.87%)of intraoperative femoral artery layer damage.One case(0.93%)of postoperative paraplegia,and 1 case(0.93%)of postoperative death.During the follow-up period of 3-48 months,3 patients died(3.75%),7 patients(8.75%)with poor blood pressure control,2 patients(2.50%)with new AD,4 patients(5.0%)with pleural effusion.Thirteen patients(16.25%)had clinical symptoms,and 1 patient(1.25%)was found to have endoleak by postoperative computed tomography angiography(CTA),but no stent morphological variation and thrombosis were found.Conclusions Stanford type B AD intervention and hybrid surgery have the advantages of definite curative effect,less complications,high safety,and uncomplicated intervention

关 键 词：主动脉夹层 主动脉腔内隔绝术 主动脉弓上分流 

分 类 号：R543.16[医药卫生—心血管疾病]