胸腹主动脉瘤治疗方法选择:附19例病例分析

The choice of treatment to thoracoabdominal aortic aneurysm:attaching analysis of 19 cases

目的分析天津医科大学总医院应用开放手术、杂交手术、腔内手术治疗胸腹主动脉瘤(TAAA)的治疗结果,探讨不同方法的适应证。方法回顾性分析天津医科大学总医院采用开放手术、杂交手术和腔内手术治疗的TAAA患者临床资料,比较3组术前一般情况、围手术期死亡率及并发症发生率等。结果 TAAA患者共19例,平均年龄为(53.0±12.9)岁。开放手术7例,杂交手术3例,腔内手术9例。开放手术组、杂交手术组、腔内手术组术后30天并发症发生率分别为71.4%(5/7)、66.7%(2/3)、11.1%(1/9)(P=0.028)。出院随访中,开放手术组术后右肾动脉分支闭塞1例,杂交手术组随访过程无并发症发生,腔内手术组术后Ⅲ型内漏1例,支架近端胸主动脉再发夹层动脉瘤1例。结论目前,3种治疗方式呈共存状态。开放手术适用于全身情况良好的年轻患者。腔内手术具有显著微创优势。随着新器材及方法的不断出现,腔内手术有成为TAAA首选治疗的趋势。对于不适用单纯腔内手术或完全开放手术的患者,可考虑杂交手术。

Objective To review and analyze outcomes of open surgery,hybrid surgery,endovascular surgery in patients with thoracoabdominal aortic aneurysm(TAAA) and explore indications of different methods.Method Clinical data of 19 cases with TAAA in Tianjin Medical University General Hospital were retrospectively analyzed.Outcome parameters included complications,mortality.Results Nineteen consecutive patients with TAAAs were presented,7 of whom underwent open surgery,3 underwent hybrid surgery,and 9 underwent endovascular surgery.Fifteen males and 4 females,age from 19 to 82 years with an mean of(53.0±12.9).At baseline,there was no significant difference in age,gender,comorbidities between the three groups(P>0.05).The 30 d complication rates in open surgery,hybrid surgery,endovascular surgery were 71.4%(5 of 7),66.7%(2 of 3),11.1%(1 of 9)(P=0.028) respectively.At the follow-up,1 case right renal artery occluded in open surgery group,no complicationoccurred in hybrid surgery group,1 case with proximal recurrent of dissection and 1 case with endoleak occurred in endovascular surgery group.Conclusion Three kinds of surgery are in coexistence state currently.Open surgery is suitable for younger patients without serious complications.Endovascular surgery is minimally invasive surgery.With the emergence of new equipment and methods,endovascular surgery has tendency to become the first-line treatment.Hybrid surgery can be performed for patients who are not suitable for open or endovascular surgery.