一站式杂交技术治疗23例冠心病合并主动脉穿透性溃疡

One-stop hybrid technique to treat coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers in 23 patients

目的回顾性分析一站式杂交技术治疗冠心病合并主动脉穿透性溃疡患者的早期临床结果。方法2016年1月至2017年12月,23例冠心病合并主动脉穿透性溃疡的患者,男21例,女2例;年龄51~79岁,平均(67.5±7.5)岁。均于体外循环下完成手术:单纯冠状动脉旁路移植术+胸主动脉覆膜支架置入术、未处理主动脉弓部2例(8.7%),主动脉弓部去分支+冠状动脉旁路移植术+胸主动脉覆膜支架置入术18例(78.3%),杂交全主动脉弓替换+冠状动脉旁路移植术+胸主动脉覆膜支架置入术3例(13.0%)。结果全组体外循环55~145 min,平均(94.3±25.7) min;主动脉阻断26~97 min,平均(61.4±19.3) min。术中出血510~900 ml,平均(654.8±78.7)ml,20例(87.0%)接受输血治疗。术后呼吸机辅助9~249 h,中位时间18 h,1例(4.3%)超过48 h;ICU停留1~23天,中位时间2.8天,6例(26.1%)超过4天。术后无死亡,主要并发症包括下肢轻瘫2例(8.7%),二次开胸止血1例(4.3%),胸腔积液1例(4.3%),气胸1例(4.3%),下肢瘫、肺部感染、急性肾功能不全、呼吸衰竭、二次气管插管1例(4.3%)。结论一站式杂交技术治疗冠心病合并主动脉穿透性溃疡早期临床结果满意,手术安全性良好,中远期结果需进一步随访研究。

Objective Retrospectively reviewed the early outcomes of one-stop hybrid technique to treat coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers (PAU). Methods This study enrolled in 23 cases (male 21, female 2) of coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers from Jan 2016 to Dec 2017 in our institute, with the mean age(67.5±7.5) years (51-79 years). Coronary artery bypass graft (CABG) surgery was performed by cardiopulmonary bypass (CPB), the procedure to treat aortic arch lesion included isolated CABG + thoracic endovascular stent graft in 2 patients, CABG + brachiocephalic arteries debranching + thoracic endovascular stent graft in 18 patients, CABG + hybrid total aortic arch replacement + thoracic endovascular stent graft in 3 patients. Results Mean CPB time was(94.3±25.7) min(55-145 min), mean aortic cross-clamp time was (61.4±19.3) min(26-97 min), intraoperative blood loss was(654.8±78.7)ml(510-900 ml), 20 patients(87.0%)needed blood transfusion therapy. Median mechanical ventilation time was 18 hours(9-249 hours), with 1 patient(4.3%)exceeded 48 hours. Median intensive care unit stay time was 2.8 days(1-23 days), with 6 patients(26.1%)exceeded 4 days. There was no in-hospital mortality. The postoperative complications included: paresis in 2 patients (8.7%), re-exploration for bleeding in 1 patient (4.3%), pleural effusion in 1 patient (4.3%), pneumothorax in 1 patient (4.3%), paraplegia、pulmonary infection、acute renal insufficiency、respiratory failure、re-intubation in 1 patient (4.3%). Conclusion The one-stop hybrid technique for treating coronary atherosclerotic disease concomitant with PAU was effective and safe. The early clinical outcome was satisfactory. Mid and long-term result need further follow-up to study.