摘要目的 对主动脉弓部病变杂交手术后常见并发症的发生原因进行分析.方法 对2001年1月至2008年12月接受杂交手术的34例主动脉弓部病变患者的资料进行回顾性分析.其中男性28例,女性6例,年龄34～75岁,平均年龄56.7岁.主动脉央层27例,其中A型21例,B型6例;主动脉弓部真性动脉瘤7例.杂交手术包括升主动脉-无名动脉-左颈总动脉Y形旁路3例,升主动脉-左颈总动脉-左锁骨下动脉Y形旁路2例,升主动脉-左颈总动脉旁路连同冠状动脉旁路移植1例,左颈总动脉-右颈总动脉旁路13例,右颈总动脉-左颈总动脉及左颈总动脉-左锁骨下动脉旁路3例,左锁骨下动脉-左颈总动脉-右颈总动脉Y形旁路2例,左颈总动脉-左锁骨下动脉旁路9例.一期行腔内修复26例,分期行腔内修复8例.结果 总的并发症发生率为32.4%(11/34),其中致死性并发症发生率11.8%(4/34).并发症包括主动脉央层破裂1例,脑卒中2例,吻合口漏并假件动脉瘤2例,心肌梗死1例,肺栓塞1例,颈部血肿1例,内漏3例.除4例围手术期死亡外,其余病例随访6～50个月,平均28.6个月,均健康生存.结论 肤主动脉弓部病变杂交手术后的并发症较一般腔内修复术更为多见,降低致死性并发症的发生率是该手术获得进一步推广的关键.

abstractsObjective To analyze the masons of complications after hybrid procedure in the treatment of aortic arch diseases. Methods Data from 34 consecutive patients (28 male and 6 female) of aortic arch diseases treated with hybrid procedure between January 2001 and December 2008 was analyzed retrospectively. The mean age of the patients was 56. 7 years (ranged from 34 to 75 years). Of the 34 patients, 27 were aortic dissections (21 cases of Stanford type A dissections and 6 cases of Stanford type B dissections) and 7 were aortic arch aneurysms. Hybrid procedure included ascending aorta (AA)-inaominate artery-left common carotid artery (LCCA ) bypass (n=3), AA-LCCA-Ieft subclavian artery (LSA) bypass (n=2), AA-LCCA bypass and coronary artery bypass (n=1), LCCA-right common carotid artery (RCCA) bypass (n=13), RCCA-LCCA and LCCA-ISA bypass (n=3), LSA-LCCA-RCCA bypass (n=2) and LCCA-KSA bypass (n=9). All the patients received single stage (n=26) or staged (n=8) endovascular repairs. Results The complications occurred in 32.4% (11/34), with 11.8% (4/34) of all patients having lethal complications. The complications included 1 case of rupture of aortic dissection (2.9% ), 2 cases of stroke (5.9%), 2 cases of stomal leak and pseudoaneurysm (5.9%), 1 case of myocardial infarct (2.9% ), 1 case of pulmonary embolism (2.9% ), 1 case of neck hernatoma (2.9%) and 3 cases of endoleak (8.8%). In the period of follow-up (6 to 50 months), all patients were alive except for 4 perioperative deaths. Conclusions Complication rate of hybrid procedure in the treatment of aortic arch diseases is higher than that of simple endovascular repair of discending aortic diseases. Reducing the lethal complications is the key to disseminate this technique.