原位开窗联合烟囱技术对主动脉夹层患者效果及其对形态学指标的影响

The effect of in-situ fenestration combined with chimney technique in the treatment of patients with aortic dissection and its influence on morphological indicators

目的探讨对主动脉夹层患者实施原位开窗联合烟囱技术治疗后,患者的预后情况和该类患者形态学指标的变化,及该治疗方法的安全性。方法选取2018-01-01-2020-12-31郑州大学第五附属医院心胸外科累及左侧颈总动脉的主动脉夹层患者95例作为研究对象,根据患者手术方式不同将其分为观察组和对照组,其中48例观察组患者为原位开窗重建左侧锁骨下支联合烟囱技术重建左侧颈总动脉,47例对照组为杂交(转流+腔内修复)手术患者,应用SPSS 24.0统计学软件对研究数据进行分析整理,对比2组患者手术指标、形态学指标、术后并发症。结果观察组手术时间为(128.76±35.42)min大于对照组(101.27±28.58)min,差异有统计学意义,t=4.158,P<0.001;观察组手术出血量为(146.82±99.83)mL小于对照组(210.45±102.24)mL,差异有统计学意义,t=3.069,P=0.003;观察组术后内漏率及手术成功率与对照组比较,差异无统计学意义,均P>0.05;观察组手术前后左锁骨下动脉的切口、气管隆突开口平面管腔面积差值与对照组相比,差异无统计学意义(均P>0.05);观察组患者手术前左锁骨下动脉真腔管径差异(12.05±3.03)mm、假腔管径差异(10.66±2.64)mm大于对照组(10.01±2.18)mm、(8.43±1.26)mm,差异有统计学意义(t=3.773,P<0.001;t=5.271,P<0.001);观察组患者手术前气管隆突开口真腔管径差异(14.74±4.21)mm、假腔管径差异(15.47±3.71)mm大于对照组(11.31±3.98)mm、(15.47±3.71)mm,差异有统计学意义(t=4.079,P<0.001;t=4.311,P<0.001);观察组患者病死率与对照组比较,差异无统计学意义(P>0.05),观察组患者出现肺部感染、脑卒中、盗血综合征、假腔血栓化、内漏等并发症的例数(9/47)例小于对照组(28/47)例,差异有统计学意义,χ^(2)=14.972,P<0.001。结论原位开窗联合烟囱技术可以提高对主动脉夹层患者的治疗效果,增强预后疗效;对患者血管管径具有优化作用,同时还可以降低患者的术后并发症发生率,提高手术安全性。

Objective To investigate the prognosis and morphologic changes of patients with aortic dissection after orthotopic fenestrectomy combined with chimney technique,and to evaluate the safety of this method.Methods ninety-five patients with aortic dissection involving the left common carotid artery from January 1 to December 31,2018 in the Department of Cardiothoracic Surgery of the Fifth Affiliated Hospital of Zhengzhou University were selected as the research objects.According to the different surgical methods,the patients were divided into observation group and control group.48 patients in situ in the observation group open a window for reconstruction of left subclavian coalition of chimney technology reconstruction of the left common carotid artery,47 cases of control group for hybridization(flow+cavity repair)surgery patients.SPSS 24.0 statistical software was used to analyze the research data.Operation index,morphological index and postoperative complications were compared between the two groups.Results The operation time of observation group(128.76±35.42)min was longer than that of control group(101.27±28.58)min,the difference was statistically significant(t=4.158,P<0.001).The amount of surgical bleeding in the observation group(146.82±99.83)mL was less than that in the control group(210.45±102.24)mL,and the difference was statistically significant(t=3.069,P=0.003).There were no significant differences in postoperative internal leakage rate and operation success rate between the observation group and the control group(P>0.05).There was no significant difference in the incision area of the left subclavian artery and the lumen area of the tracheal carina opening plane between the observation group and the control group before and after surgery(P>0.05).Before operation,the difference of true and false diameters of left subclavian artery in observation group were(12.05±3.03)mm and(10.66±2.64)mm,respectively,larger than those in control group(10.01±2.18)mm and(8.43±1.26)mm,and the difference was statistically significant(t=3.773,P<0.001;t=5.271,P<0.001);Before surgery,the difference of true and false lumen diameters in the observation group were(14.74±4.21)mm and(15.47±3.71)mm,which were greater than those in the control group(11.31±3.98)mm and(15.47±3.71)mm,and the difference was statistically significant(t=4.079,P<0.001;t=4.311,P<0.001);There was no significant difference in mortality between the observation group and the control group(P>0.05),and the number of patients with pulmonary infection,stroke,blood theft syndrome,pseudocavity thrombosis,internal leakage and other complications in the observation group(9/47)was less than that in the control group(28/47),the difference was statistically significant,χ^(2)=14.972,P<0.001.Conclusion In situ fenestrating combined with chimney technique can improve the therapeutic effect and enhance the prognosis of patients with aortic dissection.It can optimize the vascular diameter of patients,reduce the incidence of postoperative complications and improve the safety of surgery.