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同期杂交治疗弓部和胸腹段主动脉瘤的体会 郑月宏

郑月宏 主任医师 北京协和医院 血管外科中心
2009-06-05 1874人已读
郑月宏 主任医师
北京协和医院

北京协和医学院

北京协和医院     血管外科    100730

郑 月 宏   蔡念*  邓鸿儒*  郭昌宇*  Rui Furtado*北京协和医院血管外科中心郑月宏

通讯作者 郑 月 宏   E-Mail: yuehongzheng@yahoo.com  13811015811

*澳门特别行政区仁伯爵综合医院  外科 3002-Macau

摘要

目的:本文回顾行单中心分析手术结合微创这一新的杂交技术,同期治疗弓部、胸腹段主动脉病变的诊治体会。

方法:自2007年6月――2008年5月在澳门仁伯爵综合医院工作期间应用杂交技术,同期治疗主动脉病变5例。胸降主动脉瘤累及半弓合并夹层1例,弓降主动脉瘤1例,DebarkeyIII型急性主动脉夹层1例,累及双侧髂总、髂内动脉的肾下腹主动脉瘤2例。弓部近端锚定区分类,ZAP0区2例,ZAP2区1例。弓降主动脉瘤正中开胸行升主动脉至双侧颈总人工血管搭桥+左颈总动脉至左锁骨下动脉搭桥术,同期DSA下经股动脉释放Zenith覆膜支架。Debakey III型夹层行左颈总至左锁骨下动脉搭桥后释放覆膜支架封闭破口。对于累及双侧髂内动脉的腹主动脉瘤,预先髂内、外动脉搭桥后释放腹主动脉分叉支架。

结果:5例手术成功完成,术后即刻造影和随访CTA无内漏发生,随访期2月――10月。出血量约200――600ml之间,均未输血。1例弓部杂交术后ARDS随后肺部感染,术后三周行气管切开,经对症治疗后痊愈出院,术后三月出现急性左心衰,经控制血压(下肢)后恢复。1例术后三周进食时突因心脏意外死亡。两例弓部杂交治疗病例各颈动脉阻断时间均小于10分钟,均无神经并发症或者轻微神经症状。

结论:选择适宜的不同组合的主动脉杂交方式是本组治疗的前提。除却治疗费用高的因素之外,应用手术结合微创这一新型杂交技术治疗胸腹各段主动脉病变,有利于减少外科创伤和体外循环等所带来的血流动力学改变。

[关键词]  动脉瘤,夹层,主动脉弓,腹,杂交

Hybrid aortic endovascular repair with simultaneous supra-aortic branch or iliac artery revascularization

ZHENG Yuehong, Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medial Sciences, Beijing 100730

 CHOI Nim*, DENG Hongru*,KOUK CU *, RUI Furtado*, Department of general Surgery, Central Hospital Centre S. Januario,  Caixa Postal, 3002-Macau

ABSTRACT

BACKGROUND: Repair of aortic arch aneurysm is technically demanding and usually requiring complex circulatory management. Operative morbidity and mortality may be prohibitive with traditional surgical intervention. We described our experience with 5 hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta.

METHODS: A retrospective report was performed to evaluate this new hybrid technique.Data of 5 consecutive patients in Macau who presented with aortic aneurysm or dissection from 2007 to 2008 treated with the hybrid aorta repair were analyzed. 2 Complete surgical rerouting of the supra-aortic vessels was followed by the endovascular repair of aortic arch aneurysm with a Zenith TX2 stent graft. Hybrid left carotid-subclavian bypass with Zenith stent graft deployment covering the ostium of the LSA was performed in a Debakey type III aortic dissection case. 5 Procedure were successfully completed with exclusion of the aortic aneurysm. All stent grafts were deployed retrograde from the femoral artery in five patients.

RESULTS: Technical success with complete aneurysmal exclusion was achieved in all patients (100%). At a follow-up period of 2--10 months, there was no incidence of endoleak. Documented perioperative neurologic events did not occurred in all patients. 1 patient suffered ARDS and following treachuostmy,recovered 3 months later. There was one death resulting from a postoperative myocardial infarction 3 weeks later.

CONCLUSIONS: Hybrid arch repair provides an alternative to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

[Keywords]  aortic aneurysm,dissection, surgery, hybrid

    主动脉弓、降部动脉瘤由于严重神经并发症等具有极高手术风险,传统弓手术高并发症率和死亡率对于外科医生是极大挑战。Hybrid technique常被译作“复合”技术或“杂交”技术,最近国内外已将此技术应用于大血管病人。本文报告杂交技术治疗主动脉病变的初步体会。

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