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目的探索“一站式”Hybrid技术治疗复杂主动脉疾病的方法和临床疗效。方法纳入2012年7月至2014年12月于华中科技大学同济医学院附属同济医院采用“一站式”Hybrid手术治疗复杂主动脉疾病患者共33例,其中男31例,平均年龄(51.3±11.5)岁。33例患者中A型夹层4例、B型夹层累及主动脉弓部27例及主动脉弓瘤2例。A型夹层采取非深低温体外循环下行升主动脉置换+人工血管旁路移植术,其余患者均在全麻下行人工血管旁路移植术,之后所有患者均经股动脉入径数字减影血管造影(DSA)下行主动脉覆膜支架置入术。结果所有患者手术均成功,围术期因感染性休克死亡1例,其余均无偏瘫、截瘫、脑肺功能障碍、凝血障碍及严重感染等严重并发症发生且痊愈出院。术后平均随访13.5(3.7,24.7)个月,所有患者均存活,无严重并发症发生。1年后复查主动脉CT血管造影显示旁路人工血管及支架血流均通畅,支架无移位和内漏。结论 “一站式”Hybrid技术治疗复杂主动脉疾病,在简化手术复杂程度的同时也降低了死亡率和并发症发生率,具有较好的近期临床疗效,远期疗效有待于进一步观察。
Objective To explore the “one-stop” Hybrid technology for the treatment of complex aortic diseases and clinical efficacy. Methods A total of 33 patients with complex aortic diseases underwent “one-stop” hybrid surgery in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from July 2012 to December 2014. Among them, 31 were male and the mean age was 51.3 ± 11.5) years old. There were 4 cases of type A dissection in 33 cases, 27 cases of aortic arch and 2 cases of aortic arch tumor in type B dissection. A-type dissection to non-hypothermic cardiopulmonary bypass descending ascending aortic replacement + artificial bypass graft, the remaining patients were under general anesthesia bypass graft, all patients were by the femoral artery diameter digital subtraction angiography (DSA) descending aortic stent implantation. Results All the patients were operated successfully. One patient died of septic shock during the perioperative period, and the rest had no hemiplegia. Serious complications such as paraplegia, cerebral and pulmonary dysfunction, coagulopathy and severe infection occurred and were discharged. After an average of 13.5 (3.7,24.7) months follow-up, all patients survived without serious complications. A review of aortic CT angiography after 1 year showed that blood flow to the bypass graft and stent were unobstructed, and there was no displacement or leakage of the stent. Conclusions “One-stop ” Hybrid technology for the treatment of complicated aortic diseases, while simplifying the complexity of the operation and also reducing the incidence of mortality and complications, has good clinical efficacy in the near future, long-term efficacy needs further observation.