雜交技術治療主動脈弓部病變的近遠期結果_《中國普外基礎與臨床雜志》

作者：

張宏鵬 , 郭偉 , 劉小平 , 尹太 , 賈鑫 , 熊江 , 馬曉輝 , 張敏宏 , 許永樂

解放軍總醫院血管外科(北京100853);

關鍵詞：

胸主動脈瘤主動脈夾層主動脈弓雜交手術血管腔內治療

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目的探討雜交技術治療主動脈弓部病變的近、遠期結果。方法將我科2002年10月至2011年3月期間的28例胸主動脈瘤或夾層累及主動脈弓的患者納入本研究。男22例，女6例; 平均年齡68歲。15例為動脈粥樣硬化性胸主動脈瘤，13例為主動脈夾層。術后3、6、12個月及每年進行CT血管造影或B超隨訪。主要研究內容是手術死亡率、并發癥發生率及遠期生存率。結果12例開胸行全弓旁路術，左側頸總左側鎖骨下動脈旁路3例，右側頸總左側頸總左側鎖骨下動脈旁路11例，右側頸總左側頸總動脈旁路2例。技術成功率為92.9%(26/28)，并發癥發生率為35.7%(10/28)，手術死亡率為7.1%(2/28)，腦卒中發生率為7.1%(2/28)。隨訪時間(36±3)個月，1年通暢率為100%，3年通暢率為92.9%(26/28)，5年通暢率85.7%(24/28); 1年生存率為89.3%(25/28)，3年生存率為71.4%(20/28)，5年生存率為60.7%(17/28)。結論主動脈夾層弓部病變雜交手術的近、遠期結果滿意，進一步降低并發癥發生率將會提高患者生存率。

引用本文： 張宏鵬,郭偉,劉小平,尹太,賈鑫,熊江,馬曉輝,張敏宏,許永樂. 雜交技術治療主動脈弓部病變的近遠期結果. 中國普外基礎與臨床雜志, 2011, 18(10): 1039-1042. doi: 復制

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11.	張宏鵬，郭偉，劉小平，等．完全穿刺技術在腹主動脈瘤腔內修復術中的應用 [J]．中華外科雜志， 2010， 48（24）： 18551858．.
12.	Olsson C, Thelin S, Sthle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide populationbased study of more than 14 000 cases from 1987 to 2002 [J]. Circulation, 2006, 114(24): 26112618.
13.	Greenberg RK, Haddad F, Svensson L, et al. Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion [J]. Circulation, 2005, 112(17): 26192626.
14.	Noor N, Sadat U, Hayes PD, et al. Management of the left subclavian artery during endovascular repair of the thoracic aorta [J]. J Endovasc Ther, 2008, 15(2): 168176.
15.	郭偉，張宏鵬，劉小平，等． “煙囪”技術在主動脈弓病變腔內修復術中的應用 [J]．中華普通外科雜志， 2010， 25（7）： 536539．.
16.	Schumacher H, Von TenggKobligk H, Ostovic M, et al. Hybrid aortic procedures for endoluminal arch replacement in thoracic aneurysms and type B dissections [J]. J Cardiovasc Surg (Torino), 2006, 47(5): 509517.
17.	Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions [J]. J Vasc Surg, 2008, 48(1): 6468.
18.	Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones [J]. Eur J Vasc Endovasc Surg, 2007, 33(5): 561566.
19.	McWilliams RG, Murphy M, Hartley D, et al. In situ stentgraft fenestration to preserve the left subclavian artery [J]. J Endovasc Ther, 2004, 11(2): 170174.
20.	Wei G, Xin J, Yang D, et al. A new modular stent graft to reconstruct aortic arch [J]. Eur J Vasc Endovasc Surg, 2009, 37(5): 560565.

1. Matalanis G, Hata M, Buxton BF. A retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery [J]. Ann Thorac Cardiovasc Surg, 2003, 9(3): 174179.
2. Nakai M, Shimamoto M, Yamazaki F, et al. Longterm results after surgery for aortic arch nondissection aneurysm [J]. Kyobu Geka, 2002, 55(4): 280284.
3. Niinami H, Aomi S, Chikazawa G, et al. Progress in the treatment of aneurysms of the distal aortic arch: approach through median sternotomy [J]. J Cardiovasc Surg (Torino), 2003, 44(2): 243248.
4. Guo W, Liu X, Liang F, et al. Transcarotid artery endovascular reconstruction of the aortic arch by modified bifurcated stent graft for Stanford type A dissection [J]. Asian J Surg, 2007, 30(4): 290295.
5. Inoue K, Hosokawa H, Iwase T, et al. Aortic arch Reconstruction by transluminally placed endovascular branched stent graft [J]. Circulation, 1999, 100(19 Suppl): Ⅱ316Ⅱ321.
6. Schoder M, Lammer J, Czerny M. Endovascular aortic arch repair: hopes and certainties [J]. Eur J Vasc Endovasc Surg, 2009, 38(3): 255261.
7. Brinkman WT, Szeto WY, Bavaria JE. Stent graft treatment for transverse arch and descending thoracic aorta aneurysms [J]. Curr Opin Cardiol, 2007, 22(6): 510516.
8. Moon MC, Morales JP, Greenberg RK. The aortic arch and ascending aorta: are they within the endovascular realm? [J]. Semin Vasc Surg, 2007, 20(2): 97107.
9. Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE) [J]. Eur J Cardiothorac Surg, 1999, 16(1): 913.
10. Mitchell RS, Ishimaru S, Ehrlich MP, et al. First international summit on thoracic aortic endografting: roundtable on thoracic aortic dissection as an indication for endografting [J]. J Endovasc Ther, 2002, 9 Suppl 2: Ⅱ98Ⅱ105.
11. 張宏鵬，郭偉，劉小平，等．完全穿刺技術在腹主動脈瘤腔內修復術中的應用 [J]．中華外科雜志， 2010， 48（24）： 18551858．.
12. Olsson C, Thelin S, Sthle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide populationbased study of more than 14 000 cases from 1987 to 2002 [J]. Circulation, 2006, 114(24): 26112618.
13. Greenberg RK, Haddad F, Svensson L, et al. Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion [J]. Circulation, 2005, 112(17): 26192626.
14. Noor N, Sadat U, Hayes PD, et al. Management of the left subclavian artery during endovascular repair of the thoracic aorta [J]. J Endovasc Ther, 2008, 15(2): 168176.
15. 郭偉，張宏鵬，劉小平，等． “煙囪”技術在主動脈弓病變腔內修復術中的應用 [J]．中華普通外科雜志， 2010， 25（7）： 536539．.
16. Schumacher H, Von TenggKobligk H, Ostovic M, et al. Hybrid aortic procedures for endoluminal arch replacement in thoracic aneurysms and type B dissections [J]. J Cardiovasc Surg (Torino), 2006, 47(5): 509517.
17. Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions [J]. J Vasc Surg, 2008, 48(1): 6468.
18. Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones [J]. Eur J Vasc Endovasc Surg, 2007, 33(5): 561566.
19. McWilliams RG, Murphy M, Hartley D, et al. In situ stentgraft fenestration to preserve the left subclavian artery [J]. J Endovasc Ther, 2004, 11(2): 170174.
20. Wei G, Xin J, Yang D, et al. A new modular stent graft to reconstruct aortic arch [J]. Eur J Vasc Endovasc Surg, 2009, 37(5): 560565.

《中國普外基礎與臨床雜志》

雜交技術治療主動脈弓部病變的近遠期結果

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《中國普外基礎與臨床雜志》

雜交技術治療主動脈弓部病變的近遠期結果

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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