摘要目的 观察分析复杂弓部病变不同弓上分支重建方法的早中期随访结果,为临床实践提供参考.方法 回顾分析2009年1月至2014年6月在南京医科大学第一附属医院(江苏省人民医院)血管外科行主动脉弓病变腔内治疗的患者资料,筛选其中进行了弓上分支重建的80例患者,重建方法包括杂交手术(21例,杂交组)、烟囱技术(46例,烟囱组)、单分支支架(13例,单分支组),分析患者在术后3、6、12个月及以后每年随访情况.结果 患者均获得12～72个月的随访,杂交组1例死于围术期并发症,烟囱组1例术后3年死于夹层动脉瘤破裂,单分支组1例术后6个月死于心脏病.杂交组所有重建分支血管通畅,烟囱组术后3例烟囱支架闭塞,单分支组术后2例单分支支架闭塞.术后随访中,杂交组未发现明显内漏;烟囱组2例内漏;单分支组1例内漏.烟囱组术后4例患者因远端破口接受再手术治疗,其余患者均未进行再次手术.结论 对于Z0区以及部分复杂Z1区病变,杂交手术随访结果令人满意;对于Z1、Z2区病变,烟囱技术随访结果令人满意.

abstractsObjective To observe and analyze the early-and mid-term follow-up of different aortic arch branch reconstruction methods for complicated aortic arch diseases,so as to provide references for future clinical practice.Methods Data from patients receiving intracavitary therapy for aortic arch diseases in our department from January 2009 to June 2014 were retrospectively analyzed,and the cases undergoing aortic arch branch reconstruction were screened out.A total of 80 patients received aortic arch branch reconstruction to expand the landing zone,and the reconstruction methods included hybrid surgery (n=21),chimney technology (n=46),and single-branched stent (n=13).Follows-up for all patients at 3,6 and 12 months after surgery,as well as every one year thereafter were analyzed.Results All patients were followed up for 12 to 72 months.Of them,1 case in hybrid surgery group died of perioperative complication,1 in chimney stent group died of rupture of aortic dissecting aneurysm 3 years after surgery,and 1 in single-branched stent group died of heart disease 6 months after surgery.All the reconstructed branches in hybrid surgery group kept patent,while 3 cases in chimney stent group had stent occlusion,and 2 in single branch stent group had single branch stent occlusion.No endoleak was discovered in hybrid surgery group,which was found in 2 cases in chimney stent group after surgery.One case in single branch stent group had endoleak that was discovered in follow-up at 3 months.Four cases in chimney stent group received a second surgery due to distal crevasse,while the remaining patients did not receive a second surgery.Conclusion The follow-up of hybrid surgery is satisfactory for Z0 and part of complicated Z1 lesions.The follow-up of chimney technology is satisfactory for Z1 and Z2 lesions.