Hybrid技术应用于Stanford B型主动脉夹层的近期疗效

目的探讨腔内隔绝术联合血管旁路移植术（Hybird技术）治疗破口位于弓部的StanfordB型主动脉夹层（AD）近期疗效。方法选择武汉亚洲心脏病医院2008年8月至2012年6月收治的StanfordB型AD37例，均采取腔内隔绝术，并在其术前行血管旁路移植术。其中男33例，女4例，年龄36-71（51．84±9．21）岁。主动脉夹层第一破口距左颈总动脉或左锁骨下动脉开口处均小于15mm。27例行右颈总动脉-左颈总动脉旁路移植术，2例行右颈总动脉一右锁骨下动脉旁路移植术，6例行左颈总动脉-左锁骨下动脉移植术，2例行左颈总动脉-左腋动脉移植术（左锁骨下动脉开口及近端均被夹层血肿挤压）。术后立即转人介入导管室行腔内隔绝术。共置入带膜支架42枚（双支架5例，其中4例应用带膜支架加裸金属支架）。结果（1）37例行血管旁路移植术及腔内隔绝术均顺利。术后8—24（17．97±3．88）d出院。其中1例院内死亡，近期死亡1例（随访证实出院后当日死亡，等同于近期）。其余病例均无内漏、截瘫、内脏器官缺血、脑部缺血和左上肢缺血症状，随访30d，均恢复良好。（2）术后11例出现发热，排除感染因素，考虑为腔内隔绝术后综合征，经对症处理后恢复。2例因人工血管吻合口出血再次行吻合术。2例新出现肾功能不全，分析为对比剂肾病，经治疗后恢复。术后有5例仍有胸背痛症状，复查主动脉增强CT无内漏出血，治疗后均好转出院。结论腔内隔绝术联合血管旁路移植术治疗累及主动脉弓的StanfordB型主动脉夹层是一种创伤小、疗效好的治疗方法。

Hybrid technology in treatment of Stanford type B aortic dissection：short-term results

Objective To evaluate the short-term results of hybrid procedures in the treatment for aortic arch lesions. Methods From 2008 to 2012, 37 consecutive patients with the stanford type B aortic dissections were retrospectively analysed. Inclusion requirement： aortic landing zone proximal to the left subclavian artery of less than 15 mm. Hybrid, endovascular stent grafts were selected based on dissection characteristics. Annual follow-up visits included computed tomography angiography. End points include progressive pathology, complications and survival rates. Results Surgery was successful in all patients. One patient died in hospital and one patients died within 30 days after surgery. No paraplegia, cerebral infarction and left upper limb ischemia reported. Thrombosis formed in the aortic false lumen of the graft exclusion segment in all patients. Patency was seen at short-term follow-up, without proximal endoleak, graft displacement. Conclusions Endovascular repairing combined with prosthesis by-pass was a safe and effective method for complex Stanford type B aortic dissection involving the distal arch.