Hybrid手术在复杂Stanford B型夹层中的临床应用

Clinical application of Hybrid operation in complex Stanford type B dissection

目的探讨Hybrid手术治疗累及主动脉弓部分支血管的Stanford B型主动脉夹层的临床效果及并发症。方法回顾分析2014年1月—2016年1月武汉市中心医院收治87例行Hybrid手术治疗复杂Stanford B型主动脉夹层的患者,观察其术后疗效及并发症发生情况。累及Z0区9例,行头臂干(brachiocephalic trunk,BCT)-左颈总动脉(left common carotid artery,LCCA)+BCT-左锁骨下动脉(left subclavian artery,LSA)+胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)术;累及Z1区23例,行BCT-LCCA-LSA+TEVAR术;累及Z2、3区55例,行LCCA-LSA+TEVAR术;颈部血管旁路选用8 mm Gore-Tex人工血管,TEVAR选用美敦力或先健覆膜血管支架。结果无病例死亡,术后即刻造影无病例内漏,61例术毕苏醒拔管,26例术后次日顺利脱机拔管;术后出现肾衰3例,脑梗1例;随访6～48个月,出现内漏1例,无截瘫发生,恢复良好。结论Hybrid手术治疗复杂Stanford B型主动脉夹层患者,具有微创、安全、有效的临床疗效,具有低风险、低并发症发生率的策略优势;根据患者的夹层解剖学范围以及患者的综合条件,选择个性化的Hybrid手术策略是手术成功的关键。

Objective To explore the clinical effect and complications of surgical treatment of Stanford type B aortic dissection involving aortic arch branch. Methods Retrospective review of 87 patients underwent Hybrid surgery in treatment of complex Stanford type B aortic dissection from January 2014 to January 2016, Wuhan Central Hospital, efficacy and complications were observed after operation. Nine eases in the Z0 area by braehioeephalie trunk （BCT）-left common carotid artery （LCCA）＋BCT-left subclavian artery （LSA）＋thoracic endovaseular aortic repair （TEVAR）. Twenty three eases in the Z1 area by BCT-LCCA-LSA＋TEVAR. Fifty five eases in the Z2-3 area by LCCA-LSA＋TEVAR. Results No death and no immediate postoperative angiography leakage. Sixty one eases had postoperative extubation, 26 eases had postoperative day successful extubation. Renal failure occurred in 3 eases, cerebral infaretion in 1 eases. Follow-up of 6-48 months, internal leakage in 1 eases, no paraplegia occurred and all recovered well. Conclusion The surgical treatment of Hybrid complicated Stanford type B dissection, minimally invasive, safe and effective with low risk and low complication rate. The key to the success of the operation is to select a personalized Hybrid surgical strategy, according to the anatomical dissection range of patients.