中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
12期
922-925
,共4页
许永乐%郭伟%刘小平%熊江%张宏鹏%王立军
許永樂%郭偉%劉小平%熊江%張宏鵬%王立軍
허영악%곽위%류소평%웅강%장굉붕%왕립군
主动脉疾病%人工血管%主动脉,胸%覆盖左锁骨下动脉
主動脈疾病%人工血管%主動脈,胸%覆蓋左鎖骨下動脈
주동맥질병%인공혈관%주동맥,흉%복개좌쇄골하동맥
Aortic diseases%Blood vessel prosthesis%Aorta,thoracic%Left subclavian artery
目的 比较主动脉弓部疾病腔内修复术中有选择的直接覆盖左锁骨下动脉和“烟囱”技术的优劣.方法 回顾性分析2005年1月至2013年1月期间解放军总医院血管外科收治的81例需要处理左锁骨下动脉(left subclavian artery,LSA)的主动脉弓部疾病腔内修复术(thoracic endovascular aortic repair,TEVAR)患者的临床资料,根据处理方式分为有选择的直接覆盖组(selective coverage,SC)和“烟囱”技术组(Chimney,C).分析2组的临床资料,比较2组间的技术成功率、内漏发生率、手术时间,围手术期(术后30 d以内)脑栓塞、脊髓缺血、左上肢缺血发生率和死亡率.随访远期生存率.数据统计采用x2检验,t检验,Kaplan-Meier生存分析.结果 SC组47例患者,C组34例患者.SC组和C组平均手术时间分别为(61 ±22) min、(101 ±20) min,两者差异有统计学意义(P=0.000);左上肢缺血发生率分别为23.4％、2.9％,两者差异有统计学意义(P=0.011);2组技术成功率均为100％,均未出现脊髓缺血,在其他方面差异无统计学意义.平均随访时间(20±10)个月,生存曲线差异无统计学意义.结论 有选择的覆盖左锁骨下动脉对于合适的病例是安全、有效的方式;对于需要重建左锁骨下动脉的病例,“烟囱”技术是安全、有效的.
目的 比較主動脈弓部疾病腔內脩複術中有選擇的直接覆蓋左鎖骨下動脈和“煙囪”技術的優劣.方法 迴顧性分析2005年1月至2013年1月期間解放軍總醫院血管外科收治的81例需要處理左鎖骨下動脈(left subclavian artery,LSA)的主動脈弓部疾病腔內脩複術(thoracic endovascular aortic repair,TEVAR)患者的臨床資料,根據處理方式分為有選擇的直接覆蓋組(selective coverage,SC)和“煙囪”技術組(Chimney,C).分析2組的臨床資料,比較2組間的技術成功率、內漏髮生率、手術時間,圍手術期(術後30 d以內)腦栓塞、脊髓缺血、左上肢缺血髮生率和死亡率.隨訪遠期生存率.數據統計採用x2檢驗,t檢驗,Kaplan-Meier生存分析.結果 SC組47例患者,C組34例患者.SC組和C組平均手術時間分彆為(61 ±22) min、(101 ±20) min,兩者差異有統計學意義(P=0.000);左上肢缺血髮生率分彆為23.4％、2.9％,兩者差異有統計學意義(P=0.011);2組技術成功率均為100％,均未齣現脊髓缺血,在其他方麵差異無統計學意義.平均隨訪時間(20±10)箇月,生存麯線差異無統計學意義.結論 有選擇的覆蓋左鎖骨下動脈對于閤適的病例是安全、有效的方式;對于需要重建左鎖骨下動脈的病例,“煙囪”技術是安全、有效的.
목적 비교주동맥궁부질병강내수복술중유선택적직접복개좌쇄골하동맥화“연창”기술적우렬.방법 회고성분석2005년1월지2013년1월기간해방군총의원혈관외과수치적81례수요처리좌쇄골하동맥(left subclavian artery,LSA)적주동맥궁부질병강내수복술(thoracic endovascular aortic repair,TEVAR)환자적림상자료,근거처리방식분위유선택적직접복개조(selective coverage,SC)화“연창”기술조(Chimney,C).분석2조적림상자료,비교2조간적기술성공솔、내루발생솔、수술시간,위수술기(술후30 d이내)뇌전새、척수결혈、좌상지결혈발생솔화사망솔.수방원기생존솔.수거통계채용x2검험,t검험,Kaplan-Meier생존분석.결과 SC조47례환자,C조34례환자.SC조화C조평균수술시간분별위(61 ±22) min、(101 ±20) min,량자차이유통계학의의(P=0.000);좌상지결혈발생솔분별위23.4％、2.9％,량자차이유통계학의의(P=0.011);2조기술성공솔균위100％,균미출현척수결혈,재기타방면차이무통계학의의.평균수방시간(20±10)개월,생존곡선차이무통계학의의.결론 유선택적복개좌쇄골하동맥대우합괄적병례시안전、유효적방식;대우수요중건좌쇄골하동맥적병례,“연창”기술시안전、유효적.
Objective To compare selective coverage and chimney technology of the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR).Methods Eighty-one cases were retrospectively reviewed from January 2005 to January 2013 with two different management of the LSA during TEVAR:selective coverage (SC) vs chimney (C).Technical success rates,operating time,endoleaks,and perioperative cerebrovascular accidents,spinal cord ischemia (SCI),left arm ischemic symptoms and mortality were analyzed.The survival rate was also evaluated.Statistical analysis was performed using the x2 test,t-test and Kaplan-Meier survival curve.Results There were 37 patients in group SC and 34 in group C.Operating time was (61 ± 22) min for SC,and (101 ± 20) min for C (P =0.000) ; left arm ischemic symptoms occurred in 23.4％ in group SC,and 2.9％ in group C (P =0.011).Technical success rates were 100％ and SCI were 0 for both SC and C.Endoleaks,perioperative cerebrovascular accidents,and mortality were similar between the two groups.Conclusions During TEVAR,selective coverage of the left subclavian artery is safe,effective; meanwhile,chimney technology is safe,effective for patients whose left subclavian arteries need revascularization.
