摘要目的 总结杂交技术治疗主动脉弓部病变的经验与体会.方法 回顾性分析2002年1月至2014年12月中山大学附属第一医院采用杂交技术治疗42例主动脉弓部病变患者的资料,男性39例,女性3例,年龄34 ～ 80岁,平均(53±13)岁.主动脉弓动脉瘤7例,Stanford B型主动脉夹层20例,Stanford A型主动脉夹层15例.16例同期接受开放与腔内手术,26例接受分期手术,分期手术平均间隔(7±3)d.采用Fisher确切概率法比较"胸-颈"杂交与"颈-颈"杂交患者的病死率.结果 技术成功率81.0％ (34/42),住院期间13例患者发生并发症,包括脑卒中3例(7.1％),内漏8例(19.0％,Ⅰ型6例,Ⅱ型2例),循环功能不全1例,主动脉气管瘘1例;其中死亡4例(脑卒中2例,循环功能不全1例,主动脉气管瘘1例),病死率9.5％."胸-颈"杂交手术病死率明显高于"颈-颈"杂交(4/16比0,P=0.02).随访时间2～157个月,中位随访时间65个月,失访4例.随访期间人工血管旁路导致脑卒中1例,经保守治疗后康复;支架远端内膜撕裂1例,经二次干预后痊愈;吻合口假性动脉瘤2例,经手术修复后痊愈.随访期间死亡4例,其中主动脉相关死亡2例(5.3％),总生存率为76.6％.结论 杂交技术治疗主动脉弓部病变创伤小,远期效果满意.接受"胸-颈"杂交的患者病死率较接受"颈-颈"杂交的患者高.脑卒中是重要的致死性并发症.

abstractsObjective To summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.Methods It was a retrospective study.From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University.There were 39 male and 3 female patients with a mean age of (53 ± 13) years (ranging from 34 to 80 years).Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection.After the supra-aortic debranching technique, simultaneous (n =16) or staged (n =26, mean interval (7 ± 3) days) endovascular repair were performed.Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.Results Technical success rate was 81.0％ (34/42).The overall 30-day complication rate was 31.0％ (13/42), including 3 cerebral stroke (7.1％), 8 endoleak (19.0％, including 6 type Ⅰ endoleak and 2 type Ⅱ endoleak), 1 circulatory failure, 1 aorto-tracheal fistula.The 30-day mortality was 9.5％ (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula.The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the nonascending aorta based debranching group (4/16 vs.0, P =0.02).The median time of follow-up was 64.8 (2 to 156.9) months.CT scanning was performed at 1,3 months after surgery and annually thereafter.The overall survival rate was 76.6％.During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3％).There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type Ⅰ endoleak disappeared spontaneously, and 1 type Ⅱ endoleak disappeared after secondary intervention.Conclusions Endovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes.It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement.The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group.Stroke is a critical fatal complication and should be attached attention.