杂交手术对比孙氏手术治疗急性主动脉弓部夹层的预后分析  

Prognostic analysis of hybrid surgery versus Sun′s surgery for acute dissection in the aortic arch

作　　者：张若禹 王晓棣[1] 陈文[1] 黄福华[1] 陈鑫[1] ZHANG Ruoyu;WANG Xiaodi;CHEN Wen;HUANG Fuhua;CHEN Xin(Department of Thoracic and Cardiovascular Surgery,Nanjing First Hospital Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京市第一医院心胸血管外科,江苏南京210006

出　　处：《徐州医科大学学报》2024年第6期422-429,共8页Journal of Xuzhou Medical University

基　　金：国家自然科学基金青年科学基金(81900417)。

摘　　要：目的回顾性分析杂交手术和孙氏手术治疗累及弓部的急性主动脉夹层患者术后早期和中远期预后,为临床治疗急性主动脉弓部夹层患者的手术方式选择提供参考依据。方法运用倾向性得分匹配,回顾性分析2015年1月至2023年6月于南京医科大学附属南京市第一医院收治的693例急性主动脉弓部夹层患者的临床资料。按手术方法分为2组:杂交手术组144例,孙氏手术组549例。比较2组住院期间结局和中远期预后。主要终点为全因死亡,次要终点为心血管死亡和主动脉二次手术,三级终点包括住院期间的死亡和并发症。结果经过倾向性得分匹配,本研究共生成了127对病例。与杂交手术组相比,孙氏手术组的患者具有更长的手术时间、体外循环时间和主动脉阻断时间(P<0.05),且孙氏手术组患者的谵妄发生率、输血率、新发透析发生率、机械通气时间延长发生率、重症监护室停留时间和住院时间均显著增加(P<0.05)。杂交手术组和孙氏手术组的住院死亡、中远期全因死亡与心血管死亡之间的差异均无统计学意义(P>0.05)。然而,接受孙氏手术治疗与更低的主动脉二次手术率相关(HR 0.29,95%CI 0.10-0.87,P=0.027),这些结果在未匹配的队列中也得到了验证。结论杂交手术并未改善中远期生存率,且增加了中远期主动脉二次手术的风险。然而杂交手术较孙氏手术缩短了手术时间与住院时间,减少术后并发症,在术后早期展现出优势,在临床实践中应根据患者病情谨慎应用。Objective To retrospectively analyze the postoperative early and mid-and long-term prognosis of patients with acute dissection in the aortic arch through hybrid surgery and Sun′s surgery,and provide evidence for the selection of surgical approaches for the clinical treatment of patients with acute dissection in the aortic arch.Methods Through propensity score matching,693 patients with acute dissection in the aortic arch who were admitted to Naning First Hospital Affiliated to Naning Medical University from January 2015 to June 2023 were selected and their clinical data were retrospectively analyzed.According to surgical approaches,they were divided into two groups:a hybrid surgery group(n=144)and a Sun′s surgery group(n=549).Both groups were compared for the outcomes during hospitalization and mid-and long-term prognosis.The primary outcome was all-cause mortality,the secondary outcomes were cardiovascular death and secondary aortic surgery,and the tertiary outcomes included death and complications during hospitalization.Results After propensity score matching,127 case-pairs were generated for this study.Patients in the Sun′s surgery group showed longer duration of surgery,extracorporeal circulation time,and aortic blockade time than the hybrid surgery group(P<0.05).Meanwhile,those in the Sun′s surgery group presented significant increases in delirium rate,blood transfusion rate,new dialysis rate,the rate of prolonged mechanical ventilation,the length of intensive care unit stay,and the length of hospitalization(P<0.05).No statistical differences were found between the hybrid and Sun′s surgery groups in terms of death during hospitalization,mid-and long-term all-cause death,and cardiovascular death(P>0.05).However,Sun′s surgery was associated with a lower rate of secondary aortic surgery(HR 0.29,95%CI 0.10-0.87,P=0.027).These results were validated in the unmatched cohort.Conclusions Hybrid surgery does not improve mid-and long-term survival rate and increase the risk of mid-and long-term secondary a

关 键 词：急性主动脉夹层 主动脉弓部 杂交手术 孙氏手术 并发症 生存分析 

分 类 号：R654.3[医药卫生—外科学]