杂交手术治疗复杂B型主动脉夹层5年随访结果分析

Analysis of 5-year follow-up results of hybrid surgery for complex type B aortic dissection

目的分析杂交手术治疗复杂B型主动脉夹层5年临床效果。方法回顾性分析2014—2017年华中科技大学同济医学院附属武汉中心医院应用杂交手术治疗复杂B型主动脉夹层47例患者的临床资料,其中男42例、女5例,平均年龄(54.9±11.2)岁。21例行左颈总动脉-左锁骨下动脉旁路人工血管转流术(转流组),26例行左锁骨下动脉-左颈总动脉转位术(转位组)。结果所有患者均成功接受杂交手术。两组动脉阻断时间、术中出血量差异无统计学意义(P>0.05)。随访期间全组共12例(25.5%)出现并发症,其中内漏5例(10.6%)、声音嘶哑5例(10.6%)、脑卒中/头晕2例(4.3%),无左上肢乏力、截瘫、夹层逆撕;46例(97.9%)左锁骨下动脉通畅。47例患者5年生存率100.0%。结论杂交手术治疗复杂B型主动脉夹层中远期临床效果满意,重建的左锁骨下动脉5年通畅率高,术后主要并发症为内漏和声音嘶哑。

Objective To analyze the clinical effect of hybrid surgery on complex type B aortic dissection in 5years.Methods A retrospective analysis of 47 patients with complex type B aortic dissection in the Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2014 to 2017 was conducted,including 42 males and 5 females with an average age of 54.9±11.2 years.Twenty-one patients underwent the left common carotid artery to the left subclavian artery bypass(a bypass group),and 26 patients underwent the left common carotid artery to the left subclavian artery transposition(a transposition group).Results All patients accepted hybrid surgery successfully.There was no statistical difference in arterial occlusion time or intraoperative blood loss between the two groups(P>0.05).The 5-year follow-up rate was 100.0%(47/47).During the follow-up period,12(25.5%)patients developed complications,including 5(10.6%)patients of endoleak,5(10.6%)patients of hoarseness,2(4.3%)patients of stroke/dizziness.There was no patient of left upper limb weakness,paraplegia or retrograde aotic dissection.The reconstructed left subclavian artery remained patent in 46(97.9%)patients.The overall 5-year survival rate was100.0%.Conclusion The long-term therapeutic outcome of hybrid surgery for the treatment of complex type B aortic dissection is satisfying.In 5 years,the rebuilt left subclavian artery has a remarkable patency rate.Endoleak and hoarseness are the most common surgical complications.