累及弓部主动脉夹层手术方式选择及疗效

目的:探讨累及主动脉弓部主动脉夹层手术方式选择及疗效。方法:收集2010年2月—2015年5月因主动脉弓部夹层在广州军区武汉总医院心胸外科接受手术治疗病例资料,分析其手术方式选择及理由,不同术式并发症发生率等。结果:检索出符合条件的病例92例,其中仅行胸主动脉腔内修复术(TEVAR)36例,预开窗血管支架的TEVAR 2例,封闭左锁骨下动脉的TEVAR 31例,不开胸主动脉弓分支血管旁路术+TEVAR17例(左颈总动脉-左锁骨下动脉旁路术4例,右颈总动脉-左颈总动脉-左锁骨下动脉旁路术3例,右颈总动脉-左颈总动脉术、封闭左锁骨下动脉10例),开胸主动脉弓置换术6例。2例开胸主动脉弓置换术患者术后死亡,其余术后无严重并发症发生。结论:对于累及主动脉弓部夹层,开胸主动脉弓置换术是一种成熟的治疗方式;TEVAR是的一种快速、有效、经济、术后并发症少的手术方式,并可以通过开窗、分支血管旁路术等方式扩大其应用范围。

Selection of surgical procedures and efficacy analysis in treatment of aortic dissection involving aortic arch

Objective: To analyze the selection of surgical procedures for aortic dissection involving the aortic arch and the efficacy. Methods: The clinical data of patients undergoing surgical treatment due to aortic arch dissection in Department of Cardiothoracic Surgery, Wuhan General Hospital of Guangzhou Command from February 2010 to May 2015 were collected. The selection of surgical procedures and reason for selection as well as the complications were analyzed. Results: A total of 92 eligible patients were recruited after screening. Of the patients, 36 cases underwent thoracic endovascular aortic repair (TEVAR) alone, 2 cases underwent TEVAR with prefenestrated stent graft, 31 cases underwent TEVAR with left subclavian artery coverage, 17 cases underwent non-open chest aortic arch branch bypass plus TEVAR (4 cases of left common carotid artery-left subclavian artery bypass, 3 cases of right common carotid artery-left common carotid artery-left subclavian artery bypass and 10 cases of right common carotid artery-left common carotid artery plus left subclavian artery coverage), and 6 cases underwent open aortic arch replacement. Death occurred in 2 patients after open aortic arch replacement, but on serious complications occurred in the remaining patients. Conclusion: For aortic dissection involving the aortic arch, open aortic arch replacement is a well-developed treatment method. However, TEVAR is a fast, effective and economical method with low complications, and its application can be expanded by combination with other techniques such as fenestration and branch bypss.