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|本期目录/Table of Contents|

“杂交”手术治疗弓部主动脉夹层的疗效评价

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第3期
页码:
366-370
栏目:
临床研究
出版日期:
2013-06-25

文章信息/Info

Title:
Clinical evaluation of hybrid approaches in treating aortic arch dissection
作者:
杨 剑1; 易定华1; 俞世强1; 沈桂冬2; 刘金成1; 陈文生1; 段维勋1
(1.第四军医大学西京医院心脏外科，陕西 西安 710032；2.安康中心医院心脏内科，陕西 安康 725000)
Author(s):
YANG Jian1;  YI Dinghua1;  YU Shi qiang1;  SHEN Gui dong2;  LIU Jin cheng1;  CHEN Wen sheng1;  DUAN Wei xun1
(Department of Cardiovascular surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China)
关键词:
夹层动脉瘤; “杂交”手术; 外科治疗
Keywords:
aortic dissection;  hybrid approach;  surgical treatment
分类号:
R543.1
DOI:
-
文献标识码:
A
摘要:
目的:评价人工血管旁路移植术结合腔内隔绝术的“杂交”手术用于主动脉弓部夹层动脉瘤的治疗效果。方法:对12例破口位于主动脉弓部的主动脉夹层动脉瘤患者进行了人工血管旁路移植术＋腔内隔绝术的“杂交”手术治疗。评价该方法围手术期死亡率、并发症以及术后桥血管通畅率，进行了6～48（28±11）个月的随访观察。结果:全组1例死亡，原因为等待二期腔内手术期间发生动脉瘤破裂。1例患者因并发医源性升主动脉夹层而改行全主动脉弓置换＋支架植入术，随访中1例患者出现90%人工血管狭窄，1例患者出现轻度I型内漏，经18月观察无明显变化，其余患者生存良好，未出现截瘫及其他严重并发症。结论:本文所指的“杂交”手术治疗主动脉弓部夹层动脉瘤具有良好效果。
Abstract:
AIM:To evaluate the clinical followup results of treating aortic arch dissection with the hybrid approach of bypass grafting+thoracic endovascular aortic repair (TEVAR). METHODS: Between Dec. 2006 and Dec. 2010, 12 patients (10 males and 2 females, average age 503 years) with arch dissection were admitted to our institution and were treated with the hybrid approach of bypass grafting + TEVAR. According to the classification of Criado in 2005, 2 cases were of Z0 dissection, 3 Z1 dissection, and 7 Z2 dissection and the comorbidities included aortic valve insufficiency (n=2), coronary artery disease (n=3), hypertension (n=10) and aberrant right subclavian artery (n=1). The mortality and major complication rates, and patency of graft were evaluated and all patients were followed up for an average of 28 months (6-48 months) until Dec. 2012. RESULTS: One patient died while waiting for the secondstage TEVAR operation due to aneurysm rupture. One patient turned to total arch replacement+frozen elephant trunk approach because of iatrogenic ascending aorta dissection. During the followup, Type I endoleak occurred and no obvious changes were seen in the following 18 months in one patient and 90% graft stenosis was observed in another patient. Other patients were followed up with good stent graft shape, patent blood flow and no stent graft stenosis or migration. There were no severe complications of paraplegia or other central nervous disorders. CONCLUSION: The hybrid approach of bypass grafting+TEVAR extends the application field of endovascular technique into aortic arch and is proved to be effective in treating arch dissections. This hybrid approach avoids high risk of deep hyperthermia and cardiac arrest (DHCA), and simplifies the procedure. Individualized hybrid approaches should be adopted for aortic arch dissection.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2012-12-06.
基金项目：国家十二·五科技支撑项目课题资助(2011BAI11B20)
作者简介：杨剑，副教授，博士 Email：yangjian1212@hotmail.com
更新日期/Last Update: 2013-07-16