2022年医学专题—[精品]主动脉弓复杂病变--HybridChmneyorelse.ppt

主动脉弓(zhǔdòngmàigōng)复杂病变－－Hybrid,Chimneyorelse?贾鑫、郭伟VascularandEndovascularSurgeryDepartmentChinesePLAGeneralHospital第一页，共二十二页。累及主动脉弓病变可采用(cǎiyòng)技术HybridapproachEndovascularCervical-thoracicChimneyFenestrationDebranchingBranchedStent-graftCriadoetal,JEndovascTher2002第二页，共二十二页。HybridProcedures第三页，共二十二页。杂交技术文献(wénxiàn)分析ResearchNo.LandingZoneSuccessMortalityStrokeParaplegiaEndoleakHughes2013Z0/Z1/Z2Lotfi2012Vallejo20128748/19/0955.74.639Melissano2012Ye20125148/19/0--1012616Geisbusch2011Guo20103827/11/097.423.713.12.710.5Weruman2009Chaevel200814332/35/7690.94.92.8--8.44510/4/10/2197.86.76.7022.24715/23/9--196.3614.9255/12/898420112626/0/01001540--165/8/3810190--第四页，共二十二页。Meta-analysisLandingzoneNo.ofPrimaryReinterventioIn-hospitalInitialclinicalLatepatientstechnicalsuccessmortalitysuccessnsmortalityZone0130120（）95.2%12(12%)11（8.5%）111（）88.1%0Zone113170（）83.3%16(25.8%)6（4.6%）71（84.5%）2Total261190（）90.5%28（）17.3%17（6.5%）182（）86.7%2PvalueOddsratio0.00690.03210.220.530.1642.551.931.35N/AKotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2011;54(4):1182-1186.第五页，共二十二页。Meta-analysisLandingzoneNo.ofStrokeSpinalcordinjuryTypeITypeIIpatientsendoleakendoleakZone01304(3.2%)1(0.8%)5(4%)10(10%)Zone11315(4.2%)3(2.3%)13(15.5%)8(12.9%)Total2619(3.7%)4(1.5%)18(8.6%)18(11.1%)Pvalue0.620.0050.61Oddsratio0.740.334.430.750.75KotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2011;54(4):1182-1186.第六页，共二十二页。主动脉弓杂交(zájiāo)手术临床证据•In-hospitalmortalityisrelativelylow(6.5%),neurologicalcomplicationsnear5%.•Endoleakrateisalsolow(8.6%fortypeI/III).•Limitednumber,needlargevolumeandlong-termfollow-up第七页，共二十二页。ChimneyTechnique第八页，共二十二页。第九页，共二十二页。烟囱技术(jìshù)临床证据TechnicalsuccessPerioperativemortality(all-PerioperativemorbidityEndoleakStrokecause)sources0/2(0%)1/2(50%)0/2(0%)0/2(0%)2/2(100%)0/8(0%)Larzonetal,20050/8(0%)1/7(14.2%)Criadoetal,20078/8(100%)0/8(0%)0/8(0%)2/7(28.5%)1/4(25%)Baldwinetal,20086/7(85.7%)0/7(0%)1/11(9.1)Ohrlander,etal,20080/4(0%)1/7(14.1%)2/4(50%)Sugiura,etal,20093/4(75%)2/11(18.1%)a1/4(25%)2/11(18.2%)1/9(11.1%)Ciresetal,20119/11(81.8%)1/9(11.1%)0/2(0%)Yoshidaetal,20119/9(100%)1/9(11/1%)3/11(27.2%)0/8(0%)2/9(22.2%)0/2(0%)Sueetal,20112/2(100%)0/2(0%)2/8(25%)0/8(0%)0/2(0%)8/8(100%)0/8(0%)第十页，共二十二页。Meta-analysisofclinicaloutcomeswithchimneyNo.ofpatientsLandingTechnicalStrokeIEndoleakChimney(vessels)zone(Z0/Z1/Z2)successgraftspatentcy94(101)20/48/3398%5.3%18%100%Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.第十一页，共二十二页。烟囱技术临床(línchuánɡ)证据•Overallperioperativemortality(3.2%)•Morbidityrate(strokerate5.3%)•Graftpatency(100%)Allcomparabletohybridseries.Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.第十二页，共二十二页。与杂交手术(shǒushù)证据相比，烟囱技术问题•Allthechimneystentswereofflabeluse,thesamplenumbersmall,mostlessthan10cases.•Relativenew,withamedianfollow-upof11months1Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745....