摘要
目的:探讨HybridⅡ型主动脉弓修复术治疗Stanford A型主动脉夹层的有效性和安全性。方法:回顾性分析2016年12月至2019年5月河南省人民医院血管外科应用HybridⅡ型主动脉弓修复技术治疗26例Stanford A型主动脉夹层患者的临床资料,其中男性18例,女性8例,年龄(53±4.5)岁。对围术期及随访结果进行分析。结果:技术成功率为100%,升主动脉置换8例,Bentall术10例,主动脉窦部成形加升主动脉置换8例。26例患者植入主动脉覆膜支架48枚,2例远端真腔打开不良植入三枚支架;1例覆膜支架释放时移位,术中人工血管片环缩包裹加固后无并发症发生,本组无内漏发生,远端支架膨胀良好。2例(7.69%)术后死亡,其中1例肺部感染导致多脏器功能衰竭死亡,1例大面积脑梗死后循环难以维持而死亡。术后一过性术后烦躁5例(19.23%,5/26),肌力下降2例(7.69%,2/26),声音嘶哑8例(30.77%,8/26);肝功能不全2例(7.69%,2/26),肾功能不全2例(7.69%,2/26),经积极治疗均康复出院。随访3~32个月,19例(79.17%)获得随访,5例因死亡失访,失访与手术及主动脉相关并发症无关,随访期全因死亡率为20.8%(5/24)。19例存活患者随访结果满意。结论:HybridⅡ型主动脉弓修复技术在Stanford A型主动脉夹层治疗中取得良好的治疗效果,避免深低温停循环、脏器灌注不良的高危因素,缩短了手术及体外循环时间,安全有效。
Objective To explore the effectiveness and safety of TypeⅡaortic arch Hybrid debranching procedure in the treatment of Stanford type A aortic dissection.Methods A retrospective clinical study of 26 patients who suffered from Stanford type A aortic dissection,of which 18 were males,8 were females,the mean patient age was(53±4.5)years.TypeⅡaortic arch hybrid repair was performed on all of the 26 patients,of which 8 cases were performed together with replacement of ascending aorta,10 cases with Bentall procedure,8 cases with remodeling of aortic sinus as well as replacement of ascending aorta.The analysis was conducted on the perioperative period and follow-up results.Results The rate of success for the application of the technique in the 26 cases was 100%.A total of 48 aortic stent grafts were implanted in the 26 patients.There were 2 patients who required the implantation of 3 grafts due to poor opening of the distal true lumen.Stent migration occurred in 1 patient during the release of the stent graft,though it did not result in complications because using artificial blood vessels ring tightened and wrapped anastomotic between artificial blood vessel and stent graft as same surgery period.No endoleak occurred and the distal graft expanded well in 26 patients.There were 2 cases of decease after the surgery,of which 1 case experienced lung infection that led to multiple organ failure,another died of acute circulatory failure after extensive posterior cerebral infarction.The death rate was 7.69%(2/26).In terms of complications,5 patients experienced transient postoperative irritability,the incidence rate was 19.23%(5/26);2 patients experienced muscle weakness,the rate was 7.69%(2/26);8 patients experienced voice hoarseness,the rate was 30.77%(8/26);2 patients experienced liver insufficiency and 2 patients experienced renal insufficiency,the incidence rate was 7.69%(2/26)for both,they were all discharged after active treatment.During the 3-32 months of follow-up,there were 5 deaths unrelated to the surgery and a
作者
梁凯
逯党辉
张志东
崔明哲
马金辉
范玉龙
翟水亭
Liang Kai;Lu Danghui;Zhang Zhidong;Cui Mingzhe;Ma Jinhui;Fan Yulong;Zhai Shuiting(Department of Vascular Surgery,Henan Provincial Hospital,Henan Province People's Hospital,The Affiliated People's Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中华血管外科杂志》
2021年第1期11-16,共6页
Chinese Journal of Vascular Surgery
基金
河南省基础与前沿技术研究计划项目(142300410275)
河南省医学科技攻关计划项目(201702162)。
