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目的 比较两种不同方法在复杂B型主动脉夹层(type B aortic dissection,AD)中的近中期疗效.方法 回顾性分析2012年1月至2016年6月我院收治的45例复杂B型主动脉夹层患者的临床资料,其中男37例、女8例,年龄23～78岁,均合并高血压,37例为急性夹层,8例为慢性夹层.所有患者均通过大血管CT造影(computed tomography angiography,CTA)明确诊断,同时行超声心动图(UCG)排除瓣膜病变、主动脉根部和升主动脉病变、心包积液等情况.按不同的治疗方法将患者分为两组:开放手术组(open surgery,OS组)共25例,男20例、女5例,年龄(50.16±10.87)岁,主动脉弓部切开植入血管支架,转流受累的弓部分支血管;杂交手术组(hybrid technique,HT组)共20例,男18例、女2例,年龄(51.31±8.11)岁,在杂交手术室先进行弓部血管分支转流术,然后行主动脉腔内修复术(TEVAR).比较两组患者的近中期疗效.结果 两组患者均顺利出院,均无死亡或认知障碍、脑梗死、偏瘫、截瘫、昏迷等神经系统并发症.OS组中有1例患者(4.0％)术后出现急性肾损伤,经肾脏替代治疗(renal replacement therapy,RRT),出院前肾功能恢复正常;1例患者(4.0％)因心包大量积液、呼吸衰竭、肺部感染二次转入ICU;1例患者(4.0％)术后胸骨裂开行二次清创缝合术.HT组中1例患者(5.0％)术后5d再发胸痛,CTA复查示夹层逆撕致主动脉弓部、升主动脉血肿,遂行孙氏手术.术后3个月时行大血管CTA检查,OS组患者术中支架系统位置准确无移位,血流通畅,无内漏,降主动脉真腔较术前明显扩大,胸降主动脉假腔血栓形成率100.0％;HT组有1例患者(5.0％)Ⅱ型内漏,胸降主动脉假腔内血栓形成率94.7％.结论 对于弓降部锚定区不佳的B型主动脉夹层,开放手术血管支架植入花费少、效果好,但是创伤大,对外科整体团队要求高,对于手术经验丰富的中心,可优先考虑;TEVAR杂交手术创伤小、恢复快,但是花费多,并且存在内漏、逆撕等风险.“,”Objective To compare the short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B aortic dissection (AD).Methods A total of 45 patients (37 acute AD and 8 chronic AD) with complex type BAD were admitted to Nanjing First Hospital from January 2012 to June 2016,including 37 males and 8 females.All patients were confirmed by computed tomography angiography (CTA),and ultrasonic cardiogram (UCG) to rule out valvular diseases,aortic root and ascending aorta lesion,and pericardial effusion.According to different treatments,patients were divided into two groups:the open surgery group (OS group) with a total of 25 patients (20 males,5 females,a mean age of 50.16±10.87 years);the hybrid technique group (HT group) with a total 20 patients (18 males,2 females,mean age of 51.31±8.11 years).The short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type BAD were compared.Results All the patients were discharged successfully.There was no death,cognitive impairment,cerebral infarction,hemiplegia,paraplegia,coma and other neurological complications in both groups.In the OS group,one patient suffered acute kidney injury and received renal replacement therapy (RRT),whose renal function was returned to normal prior to discharge;one patient was transferred to ICU again owing to pericardial effusion,respiratory failure and lung infection;one patient underwent debridement surgery because of postoprative sternal dehiscence.In the HT group,one patient with recurrent chest pain five days after endovascular aortic repair,whose CTA showed hematoma of aortic arch and ascending aorta caused by reverse tear,underwent Sun's procedure immediately.All patients received CTA examination three months after operation in outpatient room.In the OS Group,the tear of AD was closed well by stent-graft and no leakage or shunt was detected in CTA.The rate of thrombosis formation in thoracic aortic false lumen was 100.0％.Meanwhile,in the HT Group,there was one patient with type Ⅱ leakage and the rate of thrombosis formation in thoracic aortic false lumen was 94.7％.Conclusion For complex type BAD without optimal “landing zone” in descending aorta,open surgery is recommended as the first choice for experienced team because of its less costs and perfect results;hybrid technique which can achieve quicker recovery with less surgical trauma still has serious complications such as leakage,reverse tear,and so on.