一站式杂交手术与全弓置换治疗主动脉弓病变的疗效分析

目的探讨一站式杂交手术与全弓置换处理主动脉弓部病变的疗效。方法回顾性分析2017年1月至2019年4月我院收治的29例累及主动脉弓部病变患者的临床资料,将13例行一站式杂交手术的患者纳入杂交手术组,16例行全弓置换联合支架象鼻的患者纳入全弓置换组。比较2组患者肺部感染、胸腔积液、肾损伤、神经系统损伤、心功能不全、截瘫、切口感染、用血量和住院时间等情况。结果所有患者均成功完成手术。术后2组患者肺部感染、胸腔积液、一过性肾功能损伤、切口感染、一过性意识障碍、截瘫、脑梗死/脑出血、心功能不全、移植旁路血管再发狭窄、再发主动脉夹层等术后并发症发生率比较,差异无统计学意义(P>0.05);2组患者住院时间比较,差异无统计学意义(P>0.05);杂交手术组患者用血量平均(3.69±2.89)U,全弓置换组平均(12.38±3.14)U,组间比较差异有统计学意义(P<0.05)。杂交手术组围手术期因突发心跳骤停,成功复苏后脑死亡1例,全弓置换组无围手术期死亡病例。随访1~26个月,随访期间杂交手术组出现1例覆膜支架远端夹层扩张破裂死亡病例,全弓置换组出现1例脑血管意外导致呼吸功能衰竭死亡病例,其余患者恢复良好。结论一站式杂交手术与全弓置换治疗弓部病变效果均满意,其中一站式杂交手术用血量较全弓置换组明显减少,无需深低温停循环,对年龄大、一般情况差的患者更为有利;而全弓置换组用血量更大,需要停循环、创伤大,但象鼻支架材料利于二次手术根治远端病变,适用于年轻、术前一般情况良好的患者。

Curative effect analysis of one-stop hybrid surgery and total arch replacement in the treatment of aortic arch disease

Objective To explore the efficacy of one-stop hybrid surgery and total arch replacement for aortic arch disease.MethodsThe clinical data of 29 patients with aortic arch disease admitted to our hospital from January 2017 to April 2019 were analyzed retrospectively.Thirteen cases of one-stop hybrid surgery technique were included in the hybrid surgery group,and 16 patients who underwent total arch replacement combined with stent elephant trunk technology were included in the total arch replacement group.The pulmonary infection,pleural effusion,kidney injury,nervous system injury,cardiac insufficiency,paraplegia,incision infection,blood volume and length of hospital stay were compared between the two groups.Results All patients successfully completed the operation.There was no statistically significant difference in the incidence of postoperative complications such as pulmonary infection,pleural effusion,transient renal dysfunction,incision infection,transient consciousness,paraplegia,cerebral infarction/cerebral hemorrhage,cardiac insufficiency,restenosis of graft bypass vessels,and reoccurrence of aortic dissection between the two groups(P>0.05).The length of hospital stay were not statistically significant different between the two groups(P>0.05).The blood volume in hybrid surgery group and the total arch replacement group were(3.69±2.89)U and(12.38±3.14)U respectively,the difference was statistically significant(P<0.05).In the hybrid operation group,there was 1 case of brain death after successful resuscitation due to sudden cardiac arrest in the perioperative period,and there was no perioperative death in the total arch replacement group.The patients were followed up for 1 to 26 months.One patient in hybrid surgery group died of expansion and rupture of the distal dissection of the stent graft;one patient in the total arch replacement group died of cerebrovascular accidental respiratory failure;the rest of the patients recovered well.Conclusion The one-stop hybrid surgery and total arch replacement are equally satisfactory for the treatment of aortic arch disease.One-stop hybrid surgery has significantly less blood volume than the total arch replacement group,and it does not require deep hypothermic circulatory arrest,which is more beneficial to older patients with poor general conditions.In the total arch replacement group,the blood volume was significantly increased and it requires circulatory arrest which results in great trauma.The elephant trunk stent material is beneficial to the radical treatment of distal lesions in the second operation,and is suitable for young patients with good preoperative general conditions.