目的：探讨杂交或腔内修复术治疗B型主动脉夹层合并迷走锁骨下动脉伴Kommerell憩室的疗效。方法：回顾性分析2013年1月—2016年12月收治的5例主动脉夹层合并迷走锁骨下动脉伴Kommerell憩室患者的临床资料，总结患者主动脉弓变异情况、近端破口位置、手术方式，以及围手术期与随访情况。结果：根据患者的主动脉弓变异情况与近端破口位置，2例行杂交手术，3例行单纯腔内修复术。手术时间90~538 min，平均294 min。术后即时造影显示破口封堵完全，主动脉分支或旁路血流正常。1例患者于术后1周因大面积小脑梗死而死亡，其余4例患者术后随访期间均存活，无脑部及上肢缺血症状，支架无移位，无内漏。结论：主动脉分支异常走形以及脆弱的Kommerell憩室给手术带来不便。杂交或腔内修复术治疗主动脉夹层合并迷走锁骨下动脉伴Kommerell憩室可行，但治疗经验还需要进一步积累，远期疗效有待于进一步观察。
Efficacy analysis of hybrid procedures or endovascular repair for type B aortic dissection with aberrant subclavian artery and Kommerell's diverticulum
Objective: To investigate the efficacy of hybrid procedures or endovascular repair for type B aortic dissection concomitant with aberrant subclavian artery and Kommerell’s diverticulum. Methods: The clinical data of 5 patients with type B aortic dissection complicated by aberrant subclavian artery and Kommerell’s diverticulum treated from January 2013 to December 2016 were retrospectively analyzed. The patterns of aortic arch variations, the location of the proximal tear and surgical options as well as the perioperative and follow-up results of the patients were summarized. Results: According to the patterns of aortic arch variations and location of the proximal tear of the patients, 2 cases underwent hybrid surgery and 3 cases underwent endovascular aortic repair alone. The operative time ranged from 90 to 538 min, with an average of 294 min. Postoperative immediate angiography showed the completely occluded tears, and normal blood flow in the branches of the aortic arch or bypass grafts. One patient died of massive cerebellar infarction on one week after operation but the other 4 patients were alive during postoperative follow-up period, and no symptoms of brain or upper limb ischemia were noted and no stent displacement or endoleak occurred. Conclusion: The variations of aortic arch branches along with the vascular frangibility of the Kommerell’s diverticulum cause surgical inconvenience. Hybrid surgery or endovascular repair is feasible in treatment of aortic dissection concomitant with aberrant subclavian artery and Kommerell’s diverticulum. However, the treatment experience for this condition should be further enhanced, and the long-term efficacy remains to be determined.