升主动脉包裹联合Ⅰ型杂交全主动脉弓修复术治疗主动脉弓部病变的临床疗效分析  

Clinical effect of ascending aorta banding combined with typeⅠhybrid aortic arch repair on aortic arch diseases

作　　者：马金辉 张岚林 阳晟[2] 董松波[2] 陈彧[2] 潘旭冬 许尚栋[2] 郑军[2] MA Jinhui;ZHANG Lanlin;YANG Sheng;DONG Songbo;CHEN Yu;PAN Xudong;XU Shangdong;ZHENG Jun(Department of Vascular Surgery,Henan Provincial People’s Hospital,People’s Hospital of Zhengzhou University,People’s Hospital of Henan University,Zhengzhou,450003,P.R.China;Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing Aortic Disease Centre,Beijing,100029,P.R.China)

机构地区：[1]河南省人民医院郑州大学人民医院河南大学人民医院血管外科,郑州450003 [2]首都医科大学附属北京安贞医院心血管外科北京市心肺血管疾病研究所北京市大血管疾病诊疗研究中心,北京100029

出　　处：《中国胸心血管外科临床杂志》2024年第9期1313-1318,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：北京市自然科学基金项目重点研究专题(Z210012)。

摘　　要：目的探讨升主动脉包裹联合Ⅰ型杂交全主动脉弓修复术治疗主动脉弓部病变的有效性和安全性。方法回顾性分析2019年3月—2022年3月北京安贞医院采用升主动脉包裹联合Ⅰ型杂交全主动脉弓修复术治疗累及弓部主动脉病变的临床资料。对技术成功率、围术期并发症及随访结果进行评价。结果共纳入44例患者,其中男35例、女9例,中位年龄63.0(57.5,64.6)岁,平均EuroSCOREⅡ得分8.4%±0.7%。手术技术成功率100.0%。所有患者无逆撕A型主动脉夹层和内漏发生。1例术后第5 d因多器官功能衰竭死亡,院内死亡率2.3%,其余43例患者均存活出院。所有出院患者均完成随访,随访率100.0%,中位随访时间14.5(6~42)个月。1例脊髓损伤患者于术后2年死亡,1例术后3个月因支架远端附近新发夹层行胸主动脉腔内修复术。结论升主动脉包裹联合Ⅰ型杂交全主动脉弓修复术治疗累及弓部的主动脉病变无需体外循环,包裹技术加固了近端支架锚定区,避免了逆撕A型夹层、内漏、移位等风险。手术创伤小、恢复快、死亡率低、再干预手术率低,对于高龄、高危且有复杂合并症患者是一种安全有效的治疗选择。Objective To assess the efficacy and safety of ascending aorta banding technique combined with typeⅠhybrid aortic arch repair for the aortic arch diseases.Methods The clinical data of patients undergoing ascending aorta banding technique combined with typeⅠhybrid arch repair for aortic arch diseases from March 2019 to March 2022 in Beijing Anzhen Hospital were retrospectively analyzed.The technical success,perioperative complications and follow-up results were evaluated.Results A total of 44 patients were collected,including 35 males and 9 females,with a median age of 63.0(57.5,64.6)years.The average EuroSCOREⅡscore was 8.4%±0.7%.The technical success rate was 100.0%.All patients did not have retrograde type A aortic dissection and endoleaks.One patient died of multiple organ failure 5 days after operation,the in-hospital mortality rate was 2.3%,and the remaining 43 patients survived and were discharged from hospital.The median follow-up period was 14.5(6-42)months with a follow-up rate of 100.0%.One patient with spinal cord injury died 2 years after hospital discharge.One patient underwent thoracic endovascular aortic repair at postoperative 3 months due to new entry tears near to the distal end of the stent.Conclusion Ascending aorta banding combined with typeⅠhybrid arch repair for the aortic arch diseases does not need cardio-pulmonary bypass.Ascending aorta banding technique strengthens the proximal anchoring area of the stent to avoid risks such as retrograde type A dissection,endoleak and migration.The operation owns small trauma,rapid recovery,low mortality and a low rate of reintervention,which may be considered as a safe and effective choice in the treatment of the elderly,high-risk patients with complex complications.

关 键 词：杂交手术 升主动脉包裹 胸主动脉腔内修复术 主动脉弓部病变 

分 类 号：R654.3[医药卫生—外科学]