去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较

Comparison of the outcomes between open and hybrid approaches in the treatment of thoracoabdominal aortic aneurysms repair

目的:总结和对比去分支杂交手术和传统手术治疗胸腹主动脉瘤的近远期结果。方法:回顾性分析2008年1月至2019年12月采用传统手术治疗胸腹主动脉瘤的18例患者和采用杂交手术治疗的11例患者的临床资料。杂交手术组中,夹层动脉瘤、术前合并肾功能不全以及美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分≥3分的患者比例明显高于传统手术组。结果:去分支杂交手术患者的手术时间为(445±85)min,术中出血量为(955±599)mL,术后30 d发生并发症2例,没有截瘫,死亡1例,术后30 d并发症发生率为18.2%,死亡率为9.1%。传统手术患者的手术时间为(560±245)min,术中出血量为(6100±4536)mL,术后30 d发生并发症12例,其中截瘫1例,死亡4例,术后30 d并发症发生率为66.7%,死亡率为22.2%。去分支杂交手术的术中出血量明显低于传统手术(P<0.001),30 d内并发症发生率显著降低(P=0.011)。随访期内,杂交手术组二次手术4例,死亡3例,1年、5年和10年的全因生存率分别为72%、54%和29%;传统手术组二次手术1例,死亡5例,1年、5年和10年的全因生存率分别为81%、71%和35%。杂交手术和传统手术在全因生存率和动脉瘤生存率上差异没有统计学意义。结论:去分支杂交手术是一种治疗高危胸腹主动脉瘤患者安全、有效的手术方式,术后早期并发症发生率明显低于传统手术,但中远期疗效仍需要进一步提高。

Objective:Thoracoabdominal aortic aneurysm is one of the most challenging aortic diseases.Open surgical repair remains constrained with considerable perioperative morbidity and mortality.The emergence of a hybrid approach utilizing visceral debranching with endovascular aneurysm repair has brought an alternative for high-risk patients.This study aimed to compare the short-and long-term outcomes between hybrid and open repairs in the treatment of thoracoabdominal aortic aneurysms.Methods:In this retrospectively observational study,patients with thoracoabdominal aortic aneurysm treated in a single center between January 2008 and December 2019 were reviewed,of whom 11 patients with hybrid repair,and 18 patients with open repair were identified.Demographic characteristic,operative data,perioperative morbidity and mortality,freedom from reintervention,and long-term survival were compared between the two groups.Results:In the hybrid repair group,the patients with dissection aneurysm,preoperative combined renal insufficiency,and American Society of Anesthesiologists(ASA)score of 3 or more were significantly overwhelming than in the open repair group.The operation time of debranching hybrid repair was(445±85)min,and the intraoperative blood loss was(955±599)mL.There were 2 cases of complications in the early 30 days after surgery,without paraplegia,and 1 case died.The 30-day complication rate was 18.2%,and the 30-day mortality was 9.1%.The operation time of the patients with open repair was(560±245)min,and the intraoperative blood loss was(6100±4536)mL.Twelve patients had complications in the early 30 days after surgery,including 1 paraplegia and 4 deaths within 30 days.The 30-day complication rate was 66.7%,and the 30-day mortality was 22.2%.The bleeding volume in hybrid repair was significantly reduced compared with open repair(P<0.001).Besides,the incidence of 30-day complications in hybrid surgery was significantly reduced(P=0.011).During the follow-up period,there were 4 reinterventions and 3 deaths in hybrid repair group.The 1-year,5-year,and 10-year all-cause survival rates were 72%,54%,and 29%,respectively.In open repair group,reintervention was performed in 1 case and 5 cases died,and the 1-year,5-year,and 10-year all-cause survival rates were 81%,71%,and 35%,respectively.There was no significant difference between hybrid repair and open repair in all-cause survival and aneurysm-specific survival.Conclusion:Hybrid approach utilizing visceral debranching with endovascular aneurysm repair is a safe and effective surgical method for high-risk patients with thoracoabdominal aortic aneurysms.The incidence of early postoperative complications and mortality is significantly reduced compared with traditional surgery,but the efficacy in the medium and long term still needs to be improved.