• 福建醫(yī)科大學(xué)附屬協(xié)和醫(yī)院心臟外科 福建省胸心外科研究所（福州，350001）;

目的 總結(jié)采用血管旁路移植術(shù)聯(lián)合腔內(nèi)隔絕術(shù)（endovascular aortic repair，EVAR）治療主動(dòng)脈擴(kuò)張疾病的臨床經(jīng)驗(yàn)。 方法 2008 年1 月－ 2011 年8 月，采用血管旁路移植術(shù)聯(lián)合EVAR 治療12 例主動(dòng)脈擴(kuò)張疾病患者。其中男11 例，女1 例；年齡47 ～ 81 歲，平均65.9 歲。均經(jīng)主動(dòng)脈血管造影（computed tomography angiography，CTA）確診，其中Stanford A 型夾層1 例，Stanford B 型夾層5 例，主動(dòng)脈弓部動(dòng)脈瘤4 例，腹主動(dòng)脈瘤2 例。8 例患者先行頸部血管路移植術(shù)，再行EVAR；4 例患者先行EVAR，再行股動(dòng)脈血管旁路移植術(shù)。 結(jié)果 術(shù)后肺部感染3 例，腎功能不全2 例，腦梗死1 例，血紅蛋白和血小板降低7 例，腹股溝切口愈合不良1 例。11 例患者獲隨訪3 ～ 42 個(gè)月，平均18.6 個(gè)月。1例行胸、腹主動(dòng)脈EVAR 患者，術(shù)后6 個(gè)月復(fù)查發(fā)現(xiàn)移植物遠(yuǎn)端有新的動(dòng)脈瘤形成，再次行EVAR，3 個(gè)月后復(fù)查恢復(fù)良好。其余患者術(shù)后3、6 及12 個(gè)月復(fù)查，主動(dòng)脈CTA 均提示假腔明顯縮小以及假腔內(nèi)血栓形成，未發(fā)現(xiàn)內(nèi)漏，支架無遲發(fā)變形或移位，人工血管吻合口通暢。 結(jié)論 血管旁路移植術(shù)聯(lián)合EVAR擴(kuò)大了腔內(nèi)修復(fù)術(shù)的適應(yīng)證，既提供了足夠的錨定區(qū)，又保證了重要臟器血供，簡化了手術(shù)操作過程，降低了腔內(nèi)治療難度。

引用本文： 張振龍,邱罕凡,陳良萬,陳道中,黃雪珊,曹華,林峰,黃忠耀. 血管旁路移植術(shù)聯(lián)合腔內(nèi)隔絕術(shù)治療主動(dòng)脈擴(kuò)張疾病的臨床研究. 中國修復(fù)重建外科雜志, 2012, 26(5): 583-586. doi: 復(fù)制

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1. 符偉國, 岳嘉寧. 胸腹主動(dòng)脈瘤雜交技術(shù)應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(10): 1024-1026.
2. Ehsan O, Murray D, Farquharson F, et al. Endovascular repair of complex aortic aneurysms. Ann Vasc Surg, 2011, 25(5): 716-725.
3. 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì)血管外科學(xué)組. 主動(dòng)脈夾層腔內(nèi)治療指南. 中國實(shí)用外科雜志, 2008, 28(11): 909-912.
4. Etezadi V, Schiro B, Peña CS, et al. Endovascular treatment of descending thoracic aortic disease: Single-Center, 15-Year experience. J Vasc Interv Radiol, 2012, 31(2): 78-83.
5. Thrumurthy SG, Karthikesalingam A, Patterson BO, et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(5): 632-647.
6. 景在平, 陸清聲. 主動(dòng)脈弓疾病的腔內(nèi)及雜交治療. 中國血管外科雜志 (電子版), 2010, 2(3): 133-135.
7. Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010, 39(6): 683-690.
8. Ingrund JC, Nasser F, Jesus-Silva SG, et al. Hybrid procedures for complex thoracic aortic diseases. Rev Bras Cir Cardiovasc, 2010, 25(3): 303-310.
9. Bakoyiannis C, Kalles V, Economopoulos K, et al. Hybrid procedures in the treatment of thoracoabdominal aortic aneurysms: a systematic review. J Endovasc Ther, 2009, 16(4): 443-450.
10. Patel HJ, Upchurch GR Jr, Eliason JL, et al. Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair. Ann Thorac Surg, 2010, 89(5): 1475-1481.
11. Vallejo N, Rodriguez-Lopez JA, Heidari P, et al. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. Vasc Surg, 2012, 55(2): 318-325.
12. Szeto WY, Bavaria JE, Bowen FW, et al. The hybrid total arch repair: brachiocephalic bypass and concomitant endovascular aortic arch stent graft placement. J Card Surg, 2007, 22(2): 97-102.
13. Holt PJ, Johnson C, Hinchliffe RJ, et al. Outcomes of the endovascular management of aortic arch aneurysm: implications for management of the left subclavian artery. J Vasc Surg, 2010, 51(6): 1329-1338.
14. Chung J, Kasirajan K, Veeraswamy RK, et al. Left subclavian artery coverage during thoracic endovascular aortic repair and risk of perioperative stroke or death. J Vasc Surg, 2011, 54(4): 979-984.
15. Lee TC, Andersen ND, Williams JB, et al. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg, 2011, 92(1): 97-102.
16. Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg, 2009, 22(3): 159-164.
17. Böckler D, Kotelis D, Geisbüsch P, et al. Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections——a single center experience in 28 patients. J Vasc Surg, 2008, 47(4): 724-732.
18. Farber MA, Ford PF. Hybrid procedures for thoracoabdominal aortic aneurysms. Semin Vasc Surg, 2009, 22(3): 140-144.
19. 張宏鵬, 郭偉, 劉小平, 等. 雜交技術(shù)治療胸腹主動(dòng)脈瘤. 中華外科雜志, 2009, 47(9): 657-660.
20. Zheng YH, Choi N, Deng HR, et al. Hybrid endovascular aorta repair with simultaneous supra-aortic branch or iliac branch revascularization. Chinese medical sciences journal, 2009, 24(3): 182-185.
  1. 1. 符偉國, 岳嘉寧. 胸腹主動(dòng)脈瘤雜交技術(shù)應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(10): 1024-1026.
  2. 2. Ehsan O, Murray D, Farquharson F, et al. Endovascular repair of complex aortic aneurysms. Ann Vasc Surg, 2011, 25(5): 716-725.
  3. 3. 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì)血管外科學(xué)組. 主動(dòng)脈夾層腔內(nèi)治療指南. 中國實(shí)用外科雜志, 2008, 28(11): 909-912.
  4. 4. Etezadi V, Schiro B, Peña CS, et al. Endovascular treatment of descending thoracic aortic disease: Single-Center, 15-Year experience. J Vasc Interv Radiol, 2012, 31(2): 78-83.
  5. 5. Thrumurthy SG, Karthikesalingam A, Patterson BO, et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(5): 632-647.
  6. 6. 景在平, 陸清聲. 主動(dòng)脈弓疾病的腔內(nèi)及雜交治療. 中國血管外科雜志 (電子版), 2010, 2(3): 133-135.
  7. 7. Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching and endovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010, 39(6): 683-690.
  8. 8. Ingrund JC, Nasser F, Jesus-Silva SG, et al. Hybrid procedures for complex thoracic aortic diseases. Rev Bras Cir Cardiovasc, 2010, 25(3): 303-310.
  9. 9. Bakoyiannis C, Kalles V, Economopoulos K, et al. Hybrid procedures in the treatment of thoracoabdominal aortic aneurysms: a systematic review. J Endovasc Ther, 2009, 16(4): 443-450.
  10. 10. Patel HJ, Upchurch GR Jr, Eliason JL, et al. Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair. Ann Thorac Surg, 2010, 89(5): 1475-1481.
  11. 11. Vallejo N, Rodriguez-Lopez JA, Heidari P, et al. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. Vasc Surg, 2012, 55(2): 318-325.
  12. 12. Szeto WY, Bavaria JE, Bowen FW, et al. The hybrid total arch repair: brachiocephalic bypass and concomitant endovascular aortic arch stent graft placement. J Card Surg, 2007, 22(2): 97-102.
  13. 13. Holt PJ, Johnson C, Hinchliffe RJ, et al. Outcomes of the endovascular management of aortic arch aneurysm: implications for management of the left subclavian artery. J Vasc Surg, 2010, 51(6): 1329-1338.
  14. 14. Chung J, Kasirajan K, Veeraswamy RK, et al. Left subclavian artery coverage during thoracic endovascular aortic repair and risk of perioperative stroke or death. J Vasc Surg, 2011, 54(4): 979-984.
  15. 15. Lee TC, Andersen ND, Williams JB, et al. Results with a selective revascularization strategy for left subclavian artery coverage during thoracic endovascular aortic repair. Ann Thorac Surg, 2011, 92(1): 97-102.
  16. 16. Feezor RJ, Lee WA. Management of the left subclavian artery during TEVAR. Semin Vasc Surg, 2009, 22(3): 159-164.
  17. 17. Böckler D, Kotelis D, Geisbüsch P, et al. Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections——a single center experience in 28 patients. J Vasc Surg, 2008, 47(4): 724-732.
  18. 18. Farber MA, Ford PF. Hybrid procedures for thoracoabdominal aortic aneurysms. Semin Vasc Surg, 2009, 22(3): 140-144.
  19. 19. 張宏鵬, 郭偉, 劉小平, 等. 雜交技術(shù)治療胸腹主動(dòng)脈瘤. 中華外科雜志, 2009, 47(9): 657-660.
  20. 20. Zheng YH, Choi N, Deng HR, et al. Hybrid endovascular aorta repair with simultaneous supra-aortic branch or iliac branch revascularization. Chinese medical sciences journal, 2009, 24(3): 182-185.