不同微创手术方式应用于累及主动脉弓部的Standford B型主动脉夹层的早期疗效

Early efficacy of different minimally invasive surgical approaches on Standford B aortic dissection involving the aortic arch

目的 评价不同微创手术治疗主动脉弓受累的复杂Stanford B型主动脉夹层的可行性和早期临床疗效。方法 选取2020年1月至2023年2月间在蚌埠医学院第一附属医院行微创手术治疗的Stanford B型主动脉夹层患者64名,根据弓上分支血管的重建方式为微创杂交胸主动脉腔内修复术(thoracic endovascular aortic repair, TEVAR)组(A组,36例)和完全腔内TEVAR组(B组,28例),分析两组患者围手术期的一般资料、手术时间、术后住院时间、并发症的发生情况及主动脉重塑的相关指标。结果 两组患者手术均顺利完成,术中及术后均未出现死亡、下肢缺血、截瘫、弓部逆撕及Ⅰ型内漏,围手术期并发症(新发脑梗死、截瘫、肾功能不全、谵妄、切口感染、肺部感染等)无显著差异,B组手术时间及术后住院时间低于A组,有统计学意义(P<0.05),两组患者经微创手术治疗后,主动脉受累平面真腔直径较术前增大,假腔直径较术前减小,差异有统计学意义(P<0.05),两组患者术后均可见假腔内完全血栓化,A组患者术后31例(86.11%),B组患者术后23例(82.14%)。结论 微创杂交手术和全腔内修复手术治疗累及主动脉弓部TBAD均是安全可行的,且早期疗效良好,有利于主动脉重塑。相对于微创杂交手术,全腔内修复手术可以缩短手术时间及术后住院时间,在临床治疗可优先选择。

Objective To evaluate the early efficacy and feasibility of different minimally invasive surgical methods in Stanford type B aortic dissection involving arch.Methods A total of sixty-four patients with Stanford B type aortic dissection who underwent minimally invasive surgery in the First Affiliated Hospital of Bengbu Medical College from January 2020 to February 2023 were selected.They were divided into minimally invasive hybrid TEVAR group(Group A,thirty-six cases)and complete intracavitary TEVAR group(group B,twenty-eight cases)according to the reconstruction method of branches on the aortic arch.Analyze general information,surgical duration,postoperative hospital stays,occurrence of complications,and relevant indicators of aortic remodeling in two groups of patients during the perioperative period.Results The operation was successfully completed between the two groups.There was no death,lower limb ischemia,paraplegia,reverse avulsion of arch,and type I internal leakage during and after the operation.There was no significant difference in perioperative complications(new cerebral infarction,paraplegia,renal insufficiency,delirium,incision infection,pulmonary infection,etc.).The operative time and postoperative hospital stay in group B were lower than those in group A,with statistical significance(P<0.05).After minimally invasive surgery,the true cavity diameter of the affected aortic plane increased and the false cavity diameter decreased compared with that before surgery,with statistical significance(P<0.05).Complete false lumen thrombosis was observed in both groups after surgery,with thirty-one cases(86.11%)in group A and twenty-three cases(82.14%)in group B.Conclusion Minimally invasive hybrid surgery and total endovascular repair surgery are safe and feasible in the treatment of TBAD involving aortic arch,and the early curative effect is good,which is conducive to aortic remodeling.Compared with minimally invasive hybrid surgery,total endovascular repair can shorten the operative time and postoperative hospital stays and can be preferred in clinical treatment.