杂交技术治疗胸腹主动脉瘤

Hybrid treatment for thoracoabdominal aortic aneurysms

目的总结联合传统开刀和腔内修复杂交技术治疗胸腹主动脉瘤的诊疗经验及近远期疗效。方法回顾性分析1998年9月至2008年10月杂交技术治疗15例胸腹主动脉瘤患者的临床资料。男性12例，女性3例，年龄44～72岁，平均年龄58．7岁。Ⅰ型2例，Ⅱ型8例，Ⅲ型2例，Ⅳ型3例。瘤体直径55～82mm，平均（67．5±7．5）mm。患者术后出院时，3、6、12个月及每年进行随访。结果2例顺行旁路，13例逆行旁路。手术时间6．8～12．7h，平均（8．1±1．4）h，术中出血量750～3000ml，平均（956．7±80．1）ml。围手术期病死率13．3％（2／15）。随访3～72个月，1例因急性心肌梗死死亡，其他患者无截瘫发生，无支架移位。结论杂交技术治疗胸腹主动脉瘤是可行、有效的，早期及中期治疗结果满意，但远期疗效尚待评价。

Objective To review the experience of hybrid conventional open and endovascualr treatment of thoracoabdominal aortic aneurysm （TAAA）, and evaluate the immediate and long term outcomes. Methods From September 1998 to October 2008, 15 TAAA patients were treated by hybridprocedures. The mean patient age was 58.7 years （ranged from 44 to 72 years）. The aneurysms were Crawford type Ⅰ in 2, type Ⅱ in 8, type Ⅲ in 2, type Ⅳ in 3. The median aneurysms diameter was （67. 5 ± 7.5） mm （ranged from 55 to 82 mm）. Patients were followed up before dismissal, 3, 6, 12 months later, and annually thereafter. Results Two patients were antegrade revascularization, the others were retrograde revascularization. Mean operation time was （8. 1 ± 1.4） h （ranged from 6. 8 to 12. 7 h）, mean blood loss was （956. 7 ± 80. 1 ） ml （ ranged from 750 to 3000 ml）. Two patients died during perioperative time, no paraplegia. During follow up revealed shrinkage of aneurysm, no graft migation and paraplegia, but 1 died for acute myocardial infarct. Conclusions Hybrid treatment is a safe and effective option for treatment of TAAA. Immediate and mid-term outcomes are favorable, but long-term surveillance is indefinite.