2020 年第 11 期 第 15 卷

术中支架人工血管置入术治疗外伤性主动脉弓降部病变临床分析

Clinical analysis of frozen elephant trunk implantation for traumatic injury of the distal aortic arch and descending aorta

作者：李建荣许尚栋郑军刘永民朱俊明孙立忠

英文作者：Li Jianrong Xu Shangdong Zheng Jun Liu Yongmin Zhu Junming Sun Lizhong

单位：首都医科大学附属北京安贞医院心外科北京市心肺血管疾病研究所北京市大血管外科植入式人工材料工程技术研究中心100029

英文单位：Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Engineering Research Center for Vascular Prostheses Beijing 100029 China

关键词：外伤性主动脉病变；术中支架人工血管置入术；胸主动脉腔内修复术

英文关键词：Traumaticaorticdisease;Frozenelephanttrunkimplantation;Endovascularrepairofthoracicaorta

• 摘要：

• 目的 总结术中支架人工血管置入术治疗外伤性主动脉弓降部病变的临床经验。方法 收集2009年3月至2019年1月于首都医科大学附属北京安贞医院行术中支架人工血管置入术治疗的17例外伤性主动脉弓降部病变患者的临床资料。分析患者的术前资料、手术资料、近期疗效，并随访主动脉相关事件的发生情况，通过主动脉CT血管造影观察主动脉病变愈合情况。结果 17例患者均为男性，平均年龄（39±13）岁，均为主动脉弓降部假性动脉瘤，其中3例合并B型主动脉夹层。住院期间1例死亡，1例因伤口愈合不良行清创术，其余15例患者均痊愈出院。16例患者随访12~126个月期间无死亡，1例因升主动脉吻合口瘘及术中支架人工血管远端降主动脉溃疡行升主动脉置换及降主动脉覆膜支架腔内修复术，术后恢复良好，其余15例患者主动脉破口均完全愈合。结论 术中支架人工血管置入术治疗外伤性主动脉弓降部病变，可以达到治疗主动脉损伤、恢复头臂动脉供血，预防Ⅰ型内漏、治疗合并疾病等多重目的 。

• Objective To summarize the clinical experience of the frozen elephant trunk implantation in patients with traumatic injury of the distal aortic arch and descending aorta. Methods From March 2009 to January 2019, 17 patients with traumatic injury of the distal aortic arch and descending aorta who underwent the frozen elephant trunk implantation were enrolled. The preoperative data, surgical data and short-term curative effect of the patients were analyzed, and the occurrence of aortic related events was followed up . The healing of aortic lesions was observed by aortic CT angiography. Results All the 17 patients were males with average age of （39±13）years. All of them were pseudoaneurysms in distal aortic arch and descending aorta, 3 cases of which were complicated with type B aortic dissection. One patient died during hospitalization and 1 patient underwent debridement for poor wound healing, and the other 15 patients were cured and discharged. During the follow-up of 12-126 months, there was no death in 16 patients. One patient occured proximalanastomotic leak of ascending aorta and ulcer at descending aorta , distal to frozen elephant trunk, which were successfully managed with ascending aorta replacement and endovascular stent graft repair of descending, and the aortic lacerations of the other 15 patients healed completely. ConclusionThe frozen elephant trunk implantation for patients with traumatic injury of the distal aortic arch and descending aorta can fulfill multiple purposes, including the treatment of aortic injury, restoration of the blood supply of the brachiocephalic artery, prevention of type Ⅰ endoleak, and the treatment of combined diseases.