中华外科杂志
中華外科雜誌
중화외과잡지
Chinese Journal of Surgery
2015年
11期
821-825
,共5页
郭宝磊%符伟国%郭大乔%徐欣%陈斌%蒋俊豪%杨珏%史振宇
郭寶磊%符偉國%郭大喬%徐訢%陳斌%蔣俊豪%楊玨%史振宇
곽보뢰%부위국%곽대교%서흔%진빈%장준호%양각%사진우
主动脉疾病%主动脉,胸%支架
主動脈疾病%主動脈,胸%支架
주동맥질병%주동맥,흉%지가
Aortic diseases%Aortic thoracic%Stents
目的 探讨主动脉分支动脉重建联合支架腔内修复主动脉扩张性疾病的效果.方法 回顾性分析2005年3月至2015年4月在复旦大学附属中山医院血管外科接受复合手术治疗的24例主动脉扩张性疾病患者的临床资料.男性19例(79.2％),女性5例;年龄29～69岁,平均(49±12)岁.入组患者均合并开放手术治疗的高危因素.其中14例为胸腹主动脉瘤,10例为主动脉夹层.一期或分期完成复合手术.出院后3、6、12个月及此后每年复查CT血管造影.结果 24例患者共重建分支血管74支,其中内脏血管63支,弓上分支血管11支.一期手术15例,分期手术9例.围手术期病死率为12.5％ (3/24),动脉瘤相关病死率为8.3％(2/24).人工血管分支30 d内通畅率为95.9％ (71/74).围手术期无内漏、截瘫及肠道缺血发生.4例(16.6％)术后发生急性肾功能衰竭.患者随访3～ 123个月,平均随访时间32.4个月.1例患者术后4个月发生Ⅰa型和Ⅲ型内漏;2例患者死亡.术后1年、3年的总体生存率分别为81.7％、73.5％.结论 分支动脉重建联合腔内支架修复的复合技术治疗复杂主动脉扩张性疾病的中期疗效满意,适用于基础疾病多、再次手术及不适合开放手术的高危患者.
目的 探討主動脈分支動脈重建聯閤支架腔內脩複主動脈擴張性疾病的效果.方法 迴顧性分析2005年3月至2015年4月在複旦大學附屬中山醫院血管外科接受複閤手術治療的24例主動脈擴張性疾病患者的臨床資料.男性19例(79.2％),女性5例;年齡29～69歲,平均(49±12)歲.入組患者均閤併開放手術治療的高危因素.其中14例為胸腹主動脈瘤,10例為主動脈夾層.一期或分期完成複閤手術.齣院後3、6、12箇月及此後每年複查CT血管造影.結果 24例患者共重建分支血管74支,其中內髒血管63支,弓上分支血管11支.一期手術15例,分期手術9例.圍手術期病死率為12.5％ (3/24),動脈瘤相關病死率為8.3％(2/24).人工血管分支30 d內通暢率為95.9％ (71/74).圍手術期無內漏、截癱及腸道缺血髮生.4例(16.6％)術後髮生急性腎功能衰竭.患者隨訪3～ 123箇月,平均隨訪時間32.4箇月.1例患者術後4箇月髮生Ⅰa型和Ⅲ型內漏;2例患者死亡.術後1年、3年的總體生存率分彆為81.7％、73.5％.結論 分支動脈重建聯閤腔內支架脩複的複閤技術治療複雜主動脈擴張性疾病的中期療效滿意,適用于基礎疾病多、再次手術及不適閤開放手術的高危患者.
목적 탐토주동맥분지동맥중건연합지가강내수복주동맥확장성질병적효과.방법 회고성분석2005년3월지2015년4월재복단대학부속중산의원혈관외과접수복합수술치료적24례주동맥확장성질병환자적림상자료.남성19례(79.2％),녀성5례;년령29～69세,평균(49±12)세.입조환자균합병개방수술치료적고위인소.기중14례위흉복주동맥류,10례위주동맥협층.일기혹분기완성복합수술.출원후3、6、12개월급차후매년복사CT혈관조영.결과 24례환자공중건분지혈관74지,기중내장혈관63지,궁상분지혈관11지.일기수술15례,분기수술9례.위수술기병사솔위12.5％ (3/24),동맥류상관병사솔위8.3％(2/24).인공혈관분지30 d내통창솔위95.9％ (71/74).위수술기무내루、절탄급장도결혈발생.4례(16.6％)술후발생급성신공능쇠갈.환자수방3～ 123개월,평균수방시간32.4개월.1례환자술후4개월발생Ⅰa형화Ⅲ형내루;2례환자사망.술후1년、3년적총체생존솔분별위81.7％、73.5％.결론 분지동맥중건연합강내지가수복적복합기술치료복잡주동맥확장성질병적중기료효만의,괄용우기출질병다、재차수술급불괄합개방수술적고위환자.
Objective To evaluate the effect of extensive aortic diseases (EAD) after hybrid repair with supra-arch branches or visceral arterial debranching and endovascular repair.Methods A total of 24 EAD patients (19 male and 5 female) underwent hybrid repair in Department of Vascular Surgery, Zhongshan Hospital, Fudan University between March 2005 and April 2015.The clinical data was analyzed retrospectively.The mean age was (49 ± 12) years (from 29 to 69 years).The high-risk candidates for open surgery were enrolled in the study.The patients, including 14 cases with thoracic aortic aneurysms and 10 cases with aortic dissection, were treated by one or two stages.Post-operative follow-up with CT angiography was performed at 3, 6 and 12 months and then annually thereafter.Results A total of 74 branches, including 63 with visceral arteries and 11 with supra-arch arteries, were recanalized.Nine patients were treated in two-stage hybrid procedure and fifteen were repaired by one stage.The perioperative mortality was 12.5％ (3/24), whereas the aneurysm-related mortality was 8.3％ (2/24).The 30-day patency of the grafts was 95.9％ (71/74).There was no endoleak, paralysis, and intestinal ischemia at 30 days post-hybrid procedures.Four cases (16.6％) suffered acute renal dysfunction.During the follow-up (3 to 123 months), there were two deaths and one endoleak (type Ⅰ a and Ⅲ) which emerged at 4 months post-procedure.The 1-year and 3-year survival rates were 81.7％ and 73.5％, respectively.Conclusions Hybrid treatment is safe and effective for complex EAD patients in the midterm follow-up.It is especially suitable for the high-risk patients with comorbidities, re-intervention, or little tolerance to open surgery repair.
