CAJ | 학술논문

目的：探讨复合手术技术治疗主动脉弓部病变复杂的Stanford B型胸主动脉夹层的临床疗效。方法2011年1月至2013年12月采用复合手术治疗主动脉弓部病变复杂的Stanford B型胸主动脉夹层患者33例，其中男28例，女5例，平均年龄（50±12）岁。分析围手术期及随访期（≥12个月）临床疗效及并发症发生情况。结果33例手术均顺利，技术成功率为100%，无术中死亡病例，平均住院时间22 d。术后随访3~34个月29例，失访4例，随访率87.9%；21例随访≥12个月。术后造影无Ⅰ型内漏发生，并发肺部感染1例、脑卒中1例、可逆性肾功能异常6例、逆行性A型夹层1例，无截瘫发生。术后住院期间死亡2例，病死率6.06%。随访期发生移植物感染1例、逆行性A型夹层持续存在1例，无死亡病例。结论复合手术治疗Stanford B型胸主动脉夹层围手术期及随访期并发症发生率低，具有良好的安全性与可行性，但术后部分严重并发症仍不可忽视，远期疗效尚需大样本系统性长期随访观察。
목적：탐토복합수술기술치료주동맥궁부병변복잡적Stanford B형흉주동맥협층적림상료효。방법2011년1월지2013년12월채용복합수술치료주동맥궁부병변복잡적Stanford B형흉주동맥협층환자33례，기중남28례，녀5례，평균년령（50±12）세。분석위수술기급수방기（≥12개월）림상료효급병발증발생정황。결과33례수술균순리，기술성공솔위100%，무술중사망병례，평균주원시간22 d。술후수방3~34개월29례，실방4례，수방솔87.9%；21례수방≥12개월。술후조영무Ⅰ형내루발생，병발폐부감염1례、뇌졸중1례、가역성신공능이상6례、역행성A형협층1례，무절탄발생。술후주원기간사망2례，병사솔6.06%。수방기발생이식물감염1례、역행성A형협층지속존재1례，무사망병례。결론복합수술치료Stanford B형흉주동맥협층위수술기급수방기병발증발생솔저，구유량호적안전성여가행성，단술후부분엄중병발증잉불가홀시，원기료효상수대양본계통성장기수방관찰。
Objective To evaluate the clinical effect of hybrid operation in treating Stanford type B aortic dissection. Methods During the period from January 2011 to December 2013, hybrid operation was performed in 33 patients with complex Stanford type B aortic arch dissection. The patients included 28 males and 5 females with a average age of (50±12) years. The clinical effect and the complications, occurring in perioperative period and in 24-month follow-up period, were analyzed. Results The operation was successfully accomplished in all 33 patients, with a technical success rate of 100%. The average hospitali-zation time was 20 days. After the operation, 29 cases were followed up for 3-34 months and 4 cases were lost to follow up, the following-up rate was 87.9%. In 21 cases, the following-up time was over 12 months. Postoperative angiography showed that there was no typeⅠendoleak; complications included pulmonary infection (n=1), strokes (n=1), reversible abnormal renal function (n=6) and retrograde aortic arch dissection (n=1). No paraplegia occurred. During hospitalization time, two cases died, the mortality was 6.06%. During the following-up time, graft infection occurred in one case and continued presence of retrograde aortic arch dissection was observed in one case. Conclusion The complication occurrence after hybrid operation for Stanford type B aortic dissections is low. The hybrid technique is very safe and feasible, but several serious postoperative complications should not be ignored. The long-term effectiveness needs to be further clarified by systemic and large sample studies.