CAJ | 학술논문

目的：总结自制“血管分流栓”在杂交手术治疗复杂型 Stanford B 型主动脉夹层的经验和方法。方法对40例急性复杂型 Stanford B 型主动脉夹层采用杂交手术，采用自制“血管分流栓”保持颈动脉血流重建颈部血管。结果均手术成功，术后无脑部急性缺血及左上肢缺血症状；破口封闭良好，无内漏，旁路血管通畅；2例术后死亡，1例术后3 d 发生 A 型夹层；一过性精神症状6例；左侧血胸1例；随访38例，失访2例，1例于出院后1周死亡。术后1个月、1年复查，无脑缺血及左上肢缺血症状；主动脉 CTA 均示支架无移位和内漏，移植的人工血管通畅。结论杂交手术治疗复杂型 Stanford B 型主动脉夹层安全有效，自制“血管分流栓”能保持颈动脉血流通畅，有效减少脑缺血的发生。
목적：총결자제“혈관분류전”재잡교수술치료복잡형 Stanford B 형주동맥협층적경험화방법。방법대40례급성복잡형 Stanford B 형주동맥협층채용잡교수술，채용자제“혈관분류전”보지경동맥혈류중건경부혈관。결과균수술성공，술후무뇌부급성결혈급좌상지결혈증상；파구봉폐량호，무내루，방로혈관통창；2례술후사망，1례술후3 d 발생 A 형협층；일과성정신증상6례；좌측혈흉1례；수방38례，실방2례，1례우출원후1주사망。술후1개월、1년복사，무뇌결혈급좌상지결혈증상；주동맥 CTA 균시지가무이위화내루，이식적인공혈관통창。결론잡교수술치료복잡형 Stanford B 형주동맥협층안전유효，자제“혈관분류전”능보지경동맥혈류통창，유효감소뇌결혈적발생。
Objectives To summarize the experience and methods of hybrid surgical treatment u-sing intraluminal shunt for complicated Stanford B type aortic dissection. Methods A total of 40 patients with complicated acute Stanford type B aortic dissection received hybrid procedures. Cervical arteries were reconstructed by using self-made intraluminal shunt to keep carotid arterial blood circulation. Results All the 40 patients were successfully operated. No patient experienced acute intracranial manifestations and left upper limb ischemia. Proximal crevasse were perfectly closed without endoleak and the vascular bypasses were unobstructed. There were 2 cases of perioperative death. One patient had type A aortic dissection at the 3rd day after operation. Other complications included acute renal failure(1 case),the left hemothorax (1 case)and temporary psychiatric symptoms(6 cases). A total of 38 patients were followed up,but 2 of them were lost and one of them died within the 1st week after discharge. Postoperative review at the first month and the first year showed no intracranial manifestations or left upper limb ischemia. Aortic CTA re-view showed good graft patency without stent displacement and endoleak. Conclusion Hybrid procedure is a safe and effective treatment for complicated Stanford type B aortic dissection. Self-made intraluminal shunt can maintain the carotid artery blood flow and reduce the occurrence of cerebral ischemia.