医学交流课件：主动脉弓部疾病治疗策略.pptx

1、主动脉弓部疾病治疗策略主动脉弓部疾病治疗策略DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY总方法总方法传统手术：创伤大，风险高传统手术：创伤大，风险高介入治疗（开窗，烟囱，分支支架）：介入治疗（开窗，烟囱，分支支架）：微创，需解决内漏微创，需解决内漏杂交手术：较传统手术创伤稍小杂交手术：较传统手术创伤稍小DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY传统手术传统手术前半弓，后半弓，全弓前半弓，后半弓，全弓基本需在体外

2、循环下进行基本需在体外循环下进行分支吻合法，补片吻合法分支吻合法，补片吻合法DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY升主动脉涉及前半弓的置换升主动脉涉及前半弓的置换DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY涉及前半弓的置换涉及前半弓的置换DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY涉及主动脉弓的置换涉及主动脉弓的置换

3、DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY补片法补片法DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR

4、 SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF

5、 PEKING UNIVERSITY主动脉弓部重建主动脉弓部重建DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY介入治疗例数已逐渐增加介入治疗例数已逐渐增加微创，但存在一定限制微创，但存在一定限制病变距主动脉根部常不易介入治疗病变距主动脉根

6、部常不易介入治疗方法：烟囱法，分支法，开窗法，直接方法：烟囱法，分支法，开窗法，直接封闭分支（如仅累及非优势椎动脉的左封闭分支（如仅累及非优势椎动脉的左锁骨下动脉则可直接封闭），新近有尝锁骨下动脉则可直接封闭），新近有尝试多层裸支架者试多层裸支架者有一定内漏比例有一定内漏比例DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SUR

7、GERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY患者男，57岁，主因“突发腰背部疼痛3天” 经急诊以“主动脉夹层（Stanford A型）” 入院。DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY主动脉造影决定行主动脉夹层腔内隔绝术、无名动脉覆膜支架植入术、左颈总决定行主动脉夹层腔内隔绝术、无名动脉覆膜支架植入术、左颈总动脉覆膜支架植入术

8、、左颈总动脉动脉覆膜支架植入术、左颈总动脉-左锁骨下动脉人工血管转流术。左锁骨下动脉人工血管转流术。DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY分别于无名动脉及左颈总动脉各置入导丝，调整导丝位置，使其位于主动脉超硬导丝的后方。DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY支架释放后造影DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSI

9、TY患者术后恢复情况良好；术后3周复查大动脉CTA发现内漏，考虑锁骨下动脉返流所致II型内漏。DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY术后9个月复查，各支架通畅，形态位置满意，无内漏。DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR S

10、URGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY非优势椎动脉则可直接封非优势椎动脉则可直接封堵左锁骨下动脉堵左锁骨下动脉DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VA

11、SCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY弓部三烟囱弓部三烟囱DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY弓部三烟囱弓部三烟囱DEPARTMENT OF VASCULAR S

12、URGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY5，分支支架，分支支架DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HO

13、SPITAL OF PEKING UNIVERSITY4，开窗，开窗 （预开窗、原位开窗）（预开窗、原位开窗）图片来自解放军总医院（图片来自解放军总医院（301）DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY446，M A R S多层动脉瘤修复系统多层动脉瘤修复系统“进口，昂贵进口，昂贵”DEPARTMENT OF VASCULAR SURGERY PEOPLES HOS

14、PITAL OF PEKING UNIVERSITYIt shows the carotid-carotid arterial bypass and axillary-axillary arterial bypass before sealing the left carotid and subclavian arteries. DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY杂交技术杂交技术创伤介于传统手术和介入治疗之间创伤介于传统手术和介入治疗之间胸腔外搭桥或胸腔内搭桥胸腔外搭桥或胸腔内搭桥限制较少，如

15、累及主动脉根部可行升主限制较少，如累及主动脉根部可行升主动脉置换后再支架术动脉置换后再支架术DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYIt shows the sealing of the left carotid and subclavian arteries DEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PE

16、KING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITYDEPARTMENT OF VASCULAR SURGERY PEOPLES HOSPITAL OF PEKING UNIVERSITY谢谢指导谢谢指导