'杂交手术'治疗主动脉夹层

摘要

目的 总结主动脉夹层病人行人工血管置换同时术中植入血管内支架(即"杂交手术")的外科经验.方法 主动脉夹层6例中急性Standford A型4例,其中破口分别在升主动脉2例、降主动脉1例,升降主动脉均有破口1例.行升主动脉并全弓置换同时术中于降主动脉真腔内置入血管内支架(同时行主动脉瓣成型2例、Bentall手术1例);慢性StaMford B型主动脉夹层2例,均为介入无法完成者,破口较大、均在降主动脉起始部、左锁骨下动脉下方,行近端降主动脉置换同时术中于远端降主动脉真腔内置入血管内支架.术后2周及3个月复查全主动脉螺旋CT,了解胸腹主动脉、人工血管及血管内支架情况.结果 所有病人手术成功,体外循环时间38～228 min(平均92 min).Standford A型夹层升主动脉阻断118～186 min(平均136min)、选择性脑灌注33～68min(平均49min);Standford B型夹层:1例在上、下半身分别停循环22、28 min下完成手术,另1例常温下不停循环、保持下半身灌注完成手术.术后恢复顺利,治愈出院.术后2周及3个月复查主动脉螺旋CT示人工血管血流通畅,血管内支架无内瘘及移位,支架远端主动脉真腔扩大、假腔明显缩小.结论 对于夹层撕裂范围广泛、多破口的主动脉夹层病人,行近端夹层动脉瘤切除、人工血管置换同时在远端真腔内植入血管内支架,是一种安全、有效、经济的手术方法.%Objective To summary the experience of concomitant thoratic aotic replacement and endoluminal stent grafting (socalled'Hybrid technique') for aortic dissection. Methods Four patients with acute Standford type A dissection (dissection located inascending aortic in 2 cases, descending aortic in 1, both ascending and descending aortic in 1 ) received ascending aortic and total aor-tic arch replacement and endoluminal stent grafting. Two cases with chronic Standford type B dissection, located in descending aortic,received descending aortic replaoernent and endoluminal stent grafting. Enhanced electric beam computed tomography (EBCT) wasperformed in each patient at two weeks and three months after surgery to check up the postoperative course. Results All patients suc-cessfully recovered from surgery procedure, time of cardiopulmonary bypass was 38-228 min (mean 92 min), arrest time of ascendingaortic was 118-186 min (mean 136 min) in Standford type A dissection, which time of selective cerebral perfusion was 33-68 min(mean 49 min). Tune of circulation arrest in Standford type B was 22 - 28 min. All patients were discharged from hospital. EBCT in-dicated smooth bloodstream in prosthesis, expansion of residual true lumen and reduction of false lumen, no inner-leak and no endo-stent dislocation at 2 weeks and 3 months after operation. Conclusion "Hybrid technique" (thoratic aotic replacement combined withendoluminal stent grafting) is a safe, effective and economic surgical treatment for complex aortic dissection.