主动脉弓上动脉损伤救治的临床分析

Clinic analysis of treatment for injuries of supra-arch branches

目的 分析采用不同救治方式治疗主动脉弓上动脉损伤的初步结果.方法 回顾性分析2008年1月-2017年5月山东大学附属省立医院收治的23例弓上动脉损伤患者(男性18例,女性5例)的临床资料.其中9例患者采取开放手术治疗(开放手术治疗组),13例患者采取腔内治疗(腔内治疗组),1例患者采取保守治疗.对所有存活的患者进行了1～ 60个月的电话或门诊随访,对治疗后的患者的病死率及并发症进行了评估记录,同时比较两组患者的手术时间、术后住院时间、30 d内的病死率和并发症发生率.采用SPSS 16.0软件对数据进行统计学分析,计量资料以均数±标准差((x)±s)表示,组间比较采用t检验.计数资料以频数和百分数(％)表示,组间比较采用x2检验.结果 所有患者手术均取得成功.30 d内,开放手术治疗组的患者,1例患者死亡,2例患者发生了脑梗死,但均在30 d内恢复正常.腔内治疗组的患者无死亡及脑梗死发生,但1例患者术后30 d内发生了闭塞.两组患者的手术时间[(2.4±1.1)h及(1.0±0.4)h](P＜0.01)及术后住院时间[(8.3±3.0)d及(2.5±1.0)d](P＜0.05)差异具有统计学意义.接受开放手术及腔内治疗的两组患者术后30 d内病死率分别为11.1％及0(P=0.41),并发症发生率分别为33.3％及7.7％(P=0.26),差异均无显著统计学意义.66.7％(6/9)接受开放手术的患者及92.3％(12/13)接受腔内治疗的患者在随访过程中无并发症发生.结论 初步结果显示,对于主动脉弓上动脉损伤,腔内治疗与开放手术相比可显著缩短手术时间及术后住院时间,病死率及并发症发生率略低,腔内治疗为修复弓上动脉损伤的重要方式,在抢救弓上动脉损伤方面具有特殊的作用.

Objective To analyse the initial resucts in different treatment methods for the treatment of aortic arch injury.Methods A total of 23 patients (18 males and 5 females) with injuries of superior arch arteries underwent our treatment in Shandong Provincial Hospital Affiliated to Shandong University from January 2008 to May 2017.Nine patients underwent surgical procedures(surgical group),13 patients underwent endovascular procedures (endovascular group),1 patient underwent conservative treatment.The conditions of all survived patients were followed up by telephone or outpatient from one to sixty months postoperative.Mortality and complications such as rehaemorrhagia,cerebralinfarction,stenosis or blockage during the follow-up period was assessed.Operation time,hospitalization time after treatment,mortality and complications within 30 days of surgical group and endovascular group were compared by statistical methods.The data were analyzed by SPSS 16.0 software.Measurement data were expressed as ((x) ± s).The count data were expressed as frequency and percentage (％),and comparison between groups were evaluated with t test,Chi-square.Results All patients had achieved technical success.In patients treated by surgical procedures,one case of death and 2 cases of cerebralinfarction were reported within 30 days.One patient died of rehaemorrhagia during the 2nd day of open operation.Meanwhile,another two patients suffered from cerebral infarction,they recovered within 30 days.All patients treated by endovascular procedures survived without cerebralinfarction.However,blockage occurred in one patient of these patients.The operation time [(2.4 ± 1.1) hours and (1.0 ± 0.4) hours] (P ＜ 0.01) and the time of postoperative hospitalization [(8.3 ± 3.0) days and(2.5 ± 1.0) days] (P ＜ 0.05) were statistically different of the two groups.The postoperative mortality rate of the two groups undergoing open surgery and endovascular treatment within 30 days was 11.1％ and 0.0％ (P =0.41),and complication rates with 33.3％ and 7.7％ respectively (P =0.26),there has no significant difference.Overall,66.7％ (6/9) patients treated by surgical procedures and 92.3％ (12/13) patients treated by endovascular procedures and one patient treated by consewative treatment survived without any complication during the follow up period.Conclusions Initial results suggest that endovascular procedures can significantly shorten the time of operation and the time of postoperative hospitalization,and the mortality and complication rate are also slightly lower than surgical procedures.Endovascular procedures is an important method for treatment for injuries that involve superior arch arteries.It plays a special role in rescuing injuries of superior arch arteries.