腹主动脉夹层去分支杂交手术临床分析

Clinical analysis of debranching hybrid surgery for abdominal aortic dissection

目的回顾腹主动脉夹层去分支杂交手术的诊治经验,为此类疾病治疗提供借鉴。方法2020年6月至2021年11月期间本院应用杂交手术治疗6例腹主动脉夹层患者,回顾分析其临床资料。结果6例均为主动脉夹层,其中2例Debakey I型既往行升主动脉、主动脉弓置换及术中支架植入术。4例Debakey III型中2例既往行胸主动脉覆膜支架腔内隔绝术,2例为首次诊断为腹主动脉夹层。本组6例患者均行腹主动脉夹层去分支杂交手术。均以髂动脉为流入道,行腹腔内脏动脉旁路手术,同期腹主动脉腔内修复手术。围术期共发生一过性截瘫1例,死亡1例,无脑卒中和大出血事件,5例治愈出院。结论一期腹主动脉夹层去分支杂交手术为胸腹主动脉夹层患者提供了一种新的安全有效的手术方案。

Objective To provide clinical reference for abdominal aortic dissection treated by debranching hybrid surgery.Methods Clinical data of 6 patients with abdominal aortic dissection underwent debranching hybrid repair between June 2020 and November 2021 were retrospectively analyzed.Results All 6 cases were diagnosed with aortic dissection.The previous operations in two cases of Debakey I were ascending aorta and aortic arch replacement combined with intraoperative stent implantation.Among the 4 cases of Debakey III,2 cases initially underwent thoracic endovascular aortic repair.The other 2 patients were diagnosed with abdominal aortic dissection for the first time.All 6 patients underwent open abdominal aortic debranching surgery combined with endovascular aortic repair.All 6 patients underwent abdominal visceral arteries bypass surgery with iliac artery as the inflow tract and endovascular repair.During the perioperative period,1 case experienced transient paraplegia,1 patient died of disseminated intravascular coagulation,no stroke and major hemorrhage events occurred,5 cases survived and discharged.Conclusion One-stage abdominal aortic dissection debranching hybrid surgery provides a new safe and effective surgical option for patients with thoracoabdominal aortic dissection.