复合手术治疗老年主动脉弓部疾病

目的探讨“复合”手术治疗老年主动脉弓部病变患者的临床经验及早期随访结果。方法2009年2月至2012年2月，11例主动脉弓部疾病、无法耐受开胸体外循环／深低温停循环下外科手术而接受复合手术的老年患者，其中包括主动脉瘤6例、主动脉溃疡3例和Stanford B型夹层2例。男8例，女3例；平均年龄70岁。患者先行右腋动脉至左颈总动脉和左腋动脉转流手术，然后同期进行主动脉覆膜支架腔内隔绝术覆盖左颈总动脉及左锁骨下动脉。于术后第3、6、12个月及每年进行CT血管造影或MRI复查。结果手术成功率为100％。1例于术后8天死亡、脑卒中发生率为0．0％、截瘫发生率为0．0％，仅有2例术后早期出现少量Ⅰ型内漏。随访时间（15±10）个月，无新的死亡病例发生，无迟发主动脉相关事件，发生Ⅰ型内漏者分别于术后3个月及6个月内漏消失。结论复合手术治疗老年患者主动脉弓部疾病的近期结果满意。

Hybrid repair for aortic arch lesions in the elderly

Objective To analyze the clinical experiences and short-term outcomes of hybrid repair for aortic arch lesions in elderly patients. Methods Between February 2009 and February 2012, 11 patients （8 males, 3 females） with aortic lesions who cannot endure surgical operation, including 6 aneurysms, 3 ulcers and 2 dissections, mean age 70 years, underwent hybrid repair. Right axillary artery-left carotid and axillary artery bypass were performed to create a proximal landing zone by covering the origins of the left carotid and subclavian arteries and simultaneous implantation of an endovascular stent graft into the thoracic aorta was carried out. Computed tomographic angiography or magnetic resonance imaging was performed at 3, 6, and 12 months, and annually thereafter. Results Primary technical success rate was 100%. One case died at day 8 after operation. Two patients had a mild type Ⅰ endoleak, which disappeared at 3 months and 6 months respectively. No case of stroke or paraplegia was reported. Ten patients survived after a mean follow-up of （15 ±10） months. There was no late aortic or neurologic events. Conclusion Hybrid repair is safe and effective for aortic arch lesions in the elderly with good short-term outcomes.