杂交手术治疗胸腹主动脉病变

Treatment of aortic diseases through hybrid operation

目的总结近年来应用传统开放手术和腔内修复杂交技术治疗胸腹主动脉病变的经验及效果。方法2008年6月至2011年9月收治胸腹主动脉病变患者11例，其中男性9例，女性2例，平均年龄52岁。胸腹主动脉瘤5例，胸腹主动脉夹层4例，大动脉炎并发动脉瘤2例。根据病变不同部位，首先行不同的内脏动脉或肾动脉旁路手术，再行主动脉腔内覆膜支架修复。结果手术均成功完成。同期手术平均手术时间8．5h，分期手术平均一期手术时间8．1h，平均腔内手术时间2．0h。平均随访时间13．5个月，1例患者术后3个月死于心肌梗死，无动脉瘤相关死亡，无肾功能不全和截瘫，2例发生内漏。结论杂交手术治疗胸腹主动脉病变可以减少手术创伤，是一种安全、可行的方法，早期及中期疗效满意，长期效果有待进一步随访。

Objectives To review the experience with the hybrid operations for patients with thoracoabdominal aortic diseases, as well as to evaluate and discuss the outcomes. Methods Between June 2008 and September 2011, 11 patients （9 male and 2 female, mean age 52 years） were treated by hybrid operation. Hybrid operation includes debranching of the visceral arteries, followed by endovascular repair of the diseases （include aneurysmal disease, aortic dissection, or Takayasu＇s arteritis ）. Results All the operations were successful. The mean operating time was 8.5 hours for patients done in one stage and 8.1 hours for the first stage of patient related in two stages. The endovascular stage took on average 2.0 hours. Overall mortality rate was 1/11 and morbidity was 4/1l. No aneurysm-related death occurred. Two patients developed endoleak. Permanent paraplegia and renal failure rate was 0. Mean follow-up was 13.5 months. Conclusion Hybrid operation is a mini invasive and safe method for thoracoabdominal aortic diseases with acceptable morbidity and mortality.