杂交手术治疗胸腹主动脉瘤的华西医院单中心经验

Single-center experience with hybrid surgery for thoracoabdominal aortic aneurysm in West China Hospital

目的探索杂交手术治疗胸腹主动脉瘤(thoracoabdominal aortic aneurysm,TAAA)的疗效和安全性。方法纳入2015年1月至2022年12月期间于四川大学华西医院血管外科接受杂交手术治疗的20例TAAA(包括慢性胸腹主动脉夹层动脉瘤)患者,均行逆行内脏动脉重建,一期或二期联合腔内微覆膜支架植入治疗。收集患者临床资料以及术后临床随访和影像学复查资料。结果1例患者术后16 d院内发生截瘫及急性肾功能不全,后因感染性休克于院内死亡;1例患者院内因吻合口出血行剖腹探查止血,其他患者院内均未发生严重并发症。19例出院患者均得到长期随访,随访时间10~144个月(中位随访时间48个月),患者均获得长期生存,未发生截瘫、心肌梗死、卒中或动脉瘤破裂,除1例患者接受彩超引导下瘤腔穿刺抽液外,其他患者均未接受再干预。结论杂交手术是治疗TAAA的有效治疗方法,短期和远期安全性及疗效良好。

Objective To explore the efficacy and safety of hybrid surgery in the treatment of thoracoabdominal aortic aneurysm(TAAA).Methods Twenty patients who were diagnosed with TAAA(including chronic thoracoabdominal aortic dissection aneurysm)and underwent hybrid surgery in Vascular Surgery,West China Hospital,Sichuan University were enrolled between January 2015 and December 2022.All the patients underwent retrograde reconstruction for visceral arteries in the open surgery.Additionally,one-stage or two-stage endovascular aortic repair with covered stents was performed.The patients'clinical baseline information was collected.Moreover,the patients received clinical follow-up and imaging examinations postoperatively,whose informationwas collected.Results One patient developed paraplegia and acute renal failure 16 days postoperatively in the hospital,and subsequently died in the hospital due to septic shock.Another patient underwent exploratory laparotomy for hemostasis due to anastomotic bleeding in the hospital.The other patients did not experience serious complications perioperatively.Nineteen patients were discharged from the hospital with long-term follow-up ranging from 10 to 144 months(median time:48 months),and all of them had a long-term survival.No patients were observed with paraplegia,myocardial infarction,stroke,or rupture of aneurysm.None of the patients received reintervention during the follow-up,except for one patient who underwent ultrasound-guided puncture and suctionin the aneurysmallumen.Conclusion Hybrid surgery is an effective treatment for TAAA with favorable short-and long-term safety and efficacy.