杂交手术治疗累及弓部的Stanford B型主动脉夹层的疗效分析

Effect of hybrid surgery on Stanford type B aortic dissection involving arch

目的探讨杂交手术在治疗累及弓部的Stanford B型主动脉夹层(TBAD)中的有效性和安全性。方法前瞻性描述性研究。纳入2020年1月—2021年9月蚌埠医学院第一附属医院血管外科确诊为累及弓部的TBAD患者。其中男16例,女5例;年龄32~81(59.7±12.9)岁。患者均采用外科转流术和胸主动脉腔内修复术相结合设计的新的杂交手术治疗。观察指标:患者手术时间、术中出血量、术中转流血管通畅情况、有无Ⅰ型内漏、术后卧床时间、住院费用、术后住院时间、术后并发症以及死亡等指标。术后随访观察有无支架移位、再干预、支架内血栓形成、支架内再狭窄、移植物感染、各型内漏,转流血管通畅情况及真腔通畅情况。结果患者手术均成功,术中均未出现Ⅰ型内漏。手术时间为(156.5±19.7)min,术中出血量为(70.2±25.6)mL,术后卧床时间为(4.3±1.7)d。11例患者使用人工血管行转流术,术后住院时间为(9.6±3.1)d,住院费用为(16.6±3.8)万元;另外10例使用自体大隐静脉,术后住院时间为(14.1±6.3)d,住院费用(剔除2例左颈总动脉植入支架病例)为(13.0±1.2)万元。21例患者术后仅1例出现腔隙性脑梗死,其余均未出现内脏缺血、下肢缺血、急性心功能不全、脑卒中、肺动脉栓塞、脑梗死、肺部感染和急性肾损伤等并发症,无死亡病例。21例患者术后随访时间为6~12(10.9±2.4)个月,所有患者支架无偏移,未发现内漏,支架段主动脉形态优良、真腔及血管旁路血流顺畅。患者均无再干预、支架内血栓形成、支架内再狭窄、移植物感染等情况发生。结论在短中期的疗效观察中,杂交手术治疗累及弓部的TBAD安全、有效。

Objective This study aims to evaluate the efficacy and safety of hybrid surgery in Stanford type B aortic dissection(TBAD)involving arch.Methods A prospective descriptive design was adopted.Patients with TBAD involving arch who were diagnosed in the Department of Vascular Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2020 to September 2021 were included.The patients comprised 16 males and 5 females,with average age of 32-81(59.7±12.9)years.All patients were treated with a new hybrid surgery designed in combination with surgical bypass and thoracic endovascular aortic repair.The observation targets were operation time,intraoperative bleeding,patency of intraoperative blood vessels,type Ⅰ internal leakage,postoperative bed time,hospitalization expense,postoperative hospitalization time,postoperative complications,and death.The patients were followed up for stent displacement,reintervention,in-stent thrombosis,in-stent restenosis,graft infection,various types of internal leakage,patency of bypass vessels,and patency of true lumen.Results All patients were operated successfully,and no type Ⅰ internal leakage occurred during the operation.The operation time was(156.5±19.7)min,the amount of intraoperative bleeding was(70.2±25.6)mL,and the postoperative bed rest time was(4.3±1.7)d.Eleven patients underwent bypass surgery with artificial blood vessels.The postoperative hospital stay was(9.6±3.1)d,and the hospital cost was(166±38)thousand yuan.The 10 other cases used autologous great saphenous vein,the postoperative hospital stay was(14.1±6.3)d,and the hospitalization cost(excluding 2 cases of left carotid artery stent implantation)was(130±12)thousand yuan.Except for lacunar cerebral infarction in only one patient after the operation,the other patients did not have complications such as visceral ischemia,lower limb ischemia,acute cardiac insufficiency,stroke,pulmonary embolism,cerebral infarction,pulmonary infection,and acute renal injury.The postoperative follow-up time of 21 patients was 6-12(10.9±2.4)months.All patients had no stent deviation,no internal leakage,excellent morphology of aorta in stent segment,and smooth blood flow in true lumen and vascular bypass.No re-intervention,stent thrombosis,stent restenosis,and graft infection occurred.Conclusion In the short-and medium-term efficacy observation,hybrid surgery is safe and effective for treatment of Stanford B thoracic aortic dissection involving the arch.