杂合技术在主动脉夹层病变治疗中的应用

目的探讨"杂合技术"——主动脉人工血管替换并降主动脉覆膜支架置入术治疗复杂主动脉夹层病变的效果。方法对4例主动脉夹层分离病人实施了同期外科手术结合支架置入的杂合技术治疗。结果全组手术经过顺利,主动脉阻断时间平均(147.0±30.1)min,体外循环时间平均(164.3±34.4)min,2例Stanford A型深低温停循环时间分别为45 min和43 min。1例术后因胸腔内大出血分别于术后第1 d和第8 d再次开胸止血,术后持续昏迷至第4 d清醒,气管切开接呼吸机辅助通气时间长达53 d,最终于术后77 d治愈出院。1例术后发生严重肺部感染和脓胸,最终诱发多器官功能衰竭,放弃治疗出院。另2例患者术后恢复顺利,痊愈出院。术后随访复查CTA显示升主动脉及主动脉弓部人工血管无扭曲、狭窄,血流通畅,血管内支架位置良好,降主动脉真腔较术前明显扩大,无内漏、假腔血栓形成。结论应用杂合技术治疗复杂主动脉病变方法简单,疗效可靠,并发症少,具有良好的应用前景。

Hybrid Technique in the Treatment of Aortic Dissection

Objective To investigate the ＂hybrid technology＂——artificial blood vessel replacement of aortic and descending aorta intravascular stent placement in the treatment of complex aortic diseases.MethodsFour cases of aortic dissection patients had taken the ＂hybrid＂ treatment.The 4 patients were male;coursed 2 hours to 8 years,had various degrees of chest tightness,chest pain,in whom 2 cases were Stanford A,and the other 2 cases were Stanford B.Other heart disorders included severe aortic valve insufficiency in 1 case,moderate insufficiency in 1 case and 1 case of patients with PDA,3 patients with hypertension,1 case of subcutaneous permanent pacemaker.1 patient of Stanford A type had taken the Bentall operation＋semi-arch replacement＋intravascular stent placement.Another patient of Stanford A type had taken the David＋semi-arch replacement surgery＋intravascular stent placement.1 patient of Stanford B type with PDA and moderate aortic insufficiency had taken the endovascular stent from the right femoral artery,and later accepted arterial ligation of patent ductus＋aortic valve replacement.Another case of Stanford B had left common carotid artery bypass grafting＋descending thoracic aortic endovascular stent.Results The aortic cross-clamping time was（147.0±30.1） minutes,cardiopulmonary bypass time was（164.3±34.4） minutes.In the 2 cases of deep hypothermic circulatory,the arrest time was 45 minutes and 43 minutes respectively.Postoperative empyema occurred in one cases,3 cases was cured and discharged.CTA follow-up review showed that the ascending aorta and aortic arch had no distortion,narrow,leakage or false cavity thrombosis.Conclusion The application of ＂hybrid＂ method in the treatment of complex aortic disease is simple,reliable,effective with few complications,which shows good application prospects.