主动脉Ⅱ型弓部杂交手术治疗升主动脉及弓降部病变

Type Ⅱ hybrid arch repair for complex ascending aorta and arch disease

目的总结单中心手术结合微创的杂交技术,同期治疗升主动脉及弓降部主动脉病变的体外循环经验。方法对2009年3月至2010年3月我院高危主动脉夹层患者11例采用主动脉Ⅱ型弓部杂交手术治疗的临床资料进行回顾性分析,其中Stanford A型主动脉夹层10例,Stanford B型主动脉夹层累及弓部且合并广泛主动脉扩张1例。其中胸降主动脉瘤累及半弓合并夹层1例,弓降主动脉瘤1例。行升主动脉及全主动脉弓人工血管术置换+主动脉至头臂血管搭桥+顺行腔内覆膜支架植入,弓部近端锚定区均为重建的近端锚定区。结果全组患者平均体外循环时间(124±26)min,阻断时间(46±12)min,术中最低鼻咽温度(27.9±1.4)℃。术后住院期间1例因多脏器功能衰竭死亡。1例术中支架释放后造影发现少量内漏,1例延迟苏醒,治疗后恢复出院。1例发生淋巴漏导致心包填塞,开胸结扎后好转出院。结论浅低温体外循环用于主动脉Ⅱ型弓部杂交手术治疗高危主动脉夹层病变这一新型杂交技术有利于减少外科创伤和深低温停循环等所带来损伤。

OBJECTIVE To review cardiopulmonary bypass（CPB） experiences at our center with using Type Ⅱ hybrid arch repair for proximal ascending aortic aneurysm with extension into distal arch.METHODS The medical records of 11 high-risk patients with complex aortic arch pathology who underwent hybrid procedures from March 2009 to March 2010 were reviewed retrospectively.RESULTS The mean CPB time and cross clamp time were 124±26 min and 46±12 min respectively.After operation,all patients remained incubated for an average of 18±8 h.The mean ICU stay and hospital stay were 4.3±3.1 and 11.3±3.6 days.One patient with preoperative acute renal failure died from multi-organ dysfunction post-operation.Postoperative complications included stroke in 1 patient,stent endoleaks in 1 patient,and lymphatic fistulas in 1 patient.CONCLUSION The results demonstrate hybrid treatment is a valid option for high-risk patients who do not require complete revascularization in the visceral area.