肾动脉平面以上主动脉疾病的微创治疗  

Minimally invasive treatment for diseases occurring in the supra-renal aorta

作　　者：汪忠镐[1] 张小明[2] 李鸣[3] 金炜[3] 单平[3] 谷涌泉[1] 潘松龄[3] 

机构地区：[1]首都医科大学宣武医院首都医科大学血管外科研究所,北京100053 [2]北京大学人民医院血管外科,北京100044 [3]浙江大学第一医院血管外科,杭州310003

出　　处：《中国微创外科杂志》2005年第1期11-14,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的　探讨血管移植物腔内治疗肾动脉平面以上主动脉疾病的微创治疗。　方法　 1999年 3月～ 2 0 0 3年 12月 ,在DSA监视下 ,以血管腔内微创法治疗 136例大动脉疾病 ,包括夹层动脉瘤 116例、真性胸主动脉瘤 11例、假性胸主动脉瘤 7例、主动脉缩窄 2例。最低位病变位于腹腔动脉和肠系膜动脉之间。　结果　围手术期死亡 6例 (4 4 % )。在 1枚腔内移植物到位后仍有内漏 2 5例 ,其中 2例经球囊扩张后消失 ,余 2 3例经再次植入支架移植物后内漏消失 18例 ,3例在复查中自动消失 ,2例为 1年以上的Ⅰ和Ⅱ型内漏。发生后期内漏 2例 (因移植物移位和病变发展各 1例 )。随访 1～ 4 2个月 ,平均 11个月 ,死亡 5例 (4例死因与原发病的治疗无关 ,1例为多发性胸主动脉瘤复发 ) ,失访 11例 ,114例存活。　结论　微创方法治疗高风险的大动脉病变相对安全有效 ,似有良好发展前景 ,但所用装置和释放方法有待改进 ,远期疗效尚待观察。Objective To explore the minimally invasive treatment for disorders of the supra-renal aorta by endoluminal stenting-graft. Methods Under the monitoring of DSA, a total of 136 cases with diseases of the supra-renal aorta, including 116 cases of dissecting aneurysm, 11 cases of thoracic aortic aneurysm, 7 cases of thoracic pseudoaneurysm, and 2 cases of aortic coarctation, were treated by endoluminal grafting technique between March 1999 and December 2003. The lowest lesion was located between the celiac and the mesenteric arteries. Results Six cases died in perioperative period (4.4%). Endoleaks occurred in 25 cases after the deployment of the first stent. Among them, 2 cases were sealed by balloon dilatation and the rest of 23 cases were treated by the deployment of additional stenting-graft (the leakage was corrected in 18 cases, subsided spontaneously during follow-up in 3 cases and lasted for more than one year in 2 cases as type Ⅰ and type Ⅱ, respectively). Late-stage endoleak happened in 2 cases resulting from the displacement of endograft and the progression of disease. Follow-up for 1～42 months with a mean of 11 months found 5 deaths (4 cases succumbed to causes unrelated to primary diseases and 1 cases died of the recurrence of multiple thoracic aortic aneurysms) and 114 survivors. Follow-up observations failed in 11 cases. Conclusions Minimally invasive endoluminal grafting is a relatively safe and effective means for the treatment of high-risk aortic lesions. It seems to have a prospective future, though the device and delivery system need to be improved and the long-term durability remains to be proven.

关 键 词：主动脉 夹层动脉瘤 血管腔内移植物 

分 类 号：R654.3[医药卫生—外科学]