CAJ | 학술논문

目的：总结内脏动脉重建联合主动脉腔内修复杂交手术经验。方法12例杂交手术一期或二期完成。内脏动脉重建术中制作多分支人工血管。人工血管主体与腹主动脉或髂动脉吻合，远端各分支与双侧肾动脉、肠系膜上动脉、腹腔干及其分支分别吻合。前期部分肾动脉的处理采用自体肾移植，后期完全采取人工血管旁路方案。出院后 CT 血管造影(CTA)随访各内脏动脉吻合口是否通畅。结果12例内脏动脉重建术，重建腹腔干及其分支共11支，肠系膜上动脉12支，肾动脉共18支(包括自体肾移植5支)。内脏动脉人工血管吻合方式，前期采用端侧吻合，后期优先采用端端吻合。3例发生腹膜后出血。2例自体肾移植发生肾积水、尿漏。1例内脏动脉重建术后因胸腹主动脉瘤破裂死亡。1例发生急性呼吸窘迫综合征(ARDS)后继发心功能衰竭死亡。内脏动脉重建术相关围手术期死亡率为9.1%(1/11)。无一例发生截瘫。术后 CTA 随访7例，重建内脏动脉共23支全部通畅。结论杂交手术治疗累及内脏动脉的主动脉扩张性病变有效可行。手术方案的演变表明合理的内脏动脉解剖入路、人工血管旁路设计和吻合方式是手术成功的关键因素。
목적：총결내장동맥중건연합주동맥강내수복잡교수술경험。방법12례잡교수술일기혹이기완성。내장동맥중건술중제작다분지인공혈관。인공혈관주체여복주동맥혹가동맥문합，원단각분지여쌍측신동맥、장계막상동맥、복강간급기분지분별문합。전기부분신동맥적처리채용자체신이식，후기완전채취인공혈관방로방안。출원후 CT 혈관조영(CTA)수방각내장동맥문합구시부통창。결과12례내장동맥중건술，중건복강간급기분지공11지，장계막상동맥12지，신동맥공18지(포괄자체신이식5지)。내장동맥인공혈관문합방식，전기채용단측문합，후기우선채용단단문합。3례발생복막후출혈。2례자체신이식발생신적수、뇨루。1례내장동맥중건술후인흉복주동맥류파렬사망。1례발생급성호흡군박종합정(ARDS)후계발심공능쇠갈사망。내장동맥중건술상관위수술기사망솔위9.1%(1/11)。무일례발생절탄。술후 CTA 수방7례，중건내장동맥공23지전부통창。결론잡교수술치료루급내장동맥적주동맥확장성병변유효가행。수술방안적연변표명합리적내장동맥해부입로、인공혈관방로설계화문합방식시수술성공적관건인소。
Objective To review our experiences of hybrid procedures for visceral arterial de-branching and endovascular repair of aortic pathologies.Methods Twelve hybrid procedures were per-formed in one or two stages.Multi- branch prosthetic grafts were custom- made intraoperatively. The main body of prosthetic graft was anastomosed to abdominal aorta or iliac artery.And multi-branches were anastomosed to renal artery,superior mesenteric artery and celiac trunk respectively. Renal arteries were recanalized with renal autotransplantation in most early cases and anastomosed to prosthetic graft in all late cases.The patency of visceral arteries was followed up with computed tomo-graphic angiography (CTA)after discharge.Results Eleven celiac trunks and branches,12 superior mesenteric arteries and 1 8 renal arteries including 5 arteries in renal autotransplantation were recana-lized in visceral arteries debranching of 12 cases.End - to - side approach was used in early cases while end-to-end preferred for late cases when visceral arteries and prosthetic grafts were anasto-mosed.Retroperitoneal hemorrhage occurred in 3 cases.Hydronephrosis and urine leakage occurred in renal autotransplantation of 2 cases.One patient died after visceral arterial debranching because of a rupture of thoracoabdominal aortic aneurysm.Another one died from heart failure secondary to adult respiratory distress syndrome.Periprocedural mortality due to visceral arterial debranching was 1/1 1 (9.1 %).No paraplegia occurred.CTA data from 7 cases indicated that all 23 visceral arteries were patent.Conclusions Hybrid procedure is both effective and feasible for dilating aortic lesion involving visceral arteries.And reasonable routes of exposing visceral arteries,prosthetic grafting and anasto-mosis are essential for procedural success.