血管内带膜支架治疗主动脉夹层动脉瘤6例(英文)  

Endovascular stent-grafts for aortic dissecting aneurysm in 6 cases

作　　者：王小萍[1] 苏晓蓉[2] 廖伟[1] 

机构地区：[1]赣南医学院第一附属医院心内科,江西省赣州市341000 [2]赣南医学院第一附属医院急诊科,江西省赣州市341000

出　　处：《中国组织工程研究与临床康复》2007年第43期8789-8791,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:观察血管内带膜支架在主动脉夹层中应用的有效性、可行性和安全性。方法:选择2005-03/2006-03在赣南医学院第一附属医院心内科收治的6例主动脉夹层动脉瘤患者,男3例,女3例;年龄32～67岁,平均50岁。均经胸部MRI检查及主动脉造影确诊,且符合DeBakey分型为Ⅲ型主动脉夹层。瘤体直径最大4.3cm,最小3.2cm。所有患者对手术项目均知情同意。患者发病2周后,控制血压在90～110/60～70mmHg,心率在60～65次/min情况下全麻状态下进行分别置入直筒和分叉支架(均为愈恒佳公司生产,覆膜类型为单裸头,支架均以镍钛记忆合金为材料,外覆薄层国产人造血管)。采用血管照影观察患者术后胸主动脉夹层消失情况并观察患者术后一般情况,于术后3,12个月螺旋CT复查患者恢复情况。结果:纳入患者6例均进入结果分析。①术后胸主动脉夹层消失及一般情况:6例选择的支架直径选择恰当,术后造影4例夹层消失,假腔内血栓形成,2例患者胸主动脉段夹层消失,仍可见少量造影剂内漏至假腔,但血流较缓慢。术后患者一般情况良好,生命体征平稳,均于7￣10d出院。②CT复查结果:术后3个月复查螺旋CT显示原假腔明显缩小,真腔增大接近正常。病例3可见支架折曲远端与支架血管内壁相连的小块状不规则附壁血栓形成,随访血栓增大不明显。术后12个月患者支架位置及形态均未见明显改变,生活质量明显好转。结论:血管内带膜支架在主动脉夹层中的应用是有效、可行和安全的。AIM ： To observe the efficacy, feasibility and safety of endovascular stent-grafts in treating aortic dissection METHODS ： Six patients with aortic dissecting aneurysm （3 males and 3 females, aged 32-67 years, average of 50 years old） were selected from Department of Cardiology, First Affiliated Hospital of Gannan Medical College between March 2005 and March 2006. They were diagnosed by transthoracic magnetic resonance imaging （MRI） and aortic angiography, and as type m aortic dissecting aneurysm according to Debakey typing. The tumor diameter was ranged from 3.2 to 4.3 cm. The informed consent was obtained from all patients. Two weeks after the onset, the blood pressure was control between 90-110 and 60-70 mm Hg and heart rate at 60-65 times/min, then the straight circular and bifurcated stents, the product of Yuhengjia Company, composed of single naked membrane, straight circular and bifurcated stents made of nickel-titanium memory alloy, and cover of domestic artificial blood vessel were implanted with the patients generally anesthetized. The aortic dissection and general condition of patients after operation were observed with angiography, and the patient recovery condition was examined by spiral CT at postoperative months 3 and 12. RESULTS： All 6 cases were involved in the result analysis. （1）The diameters of stents for the patients were appropriate. The angiography showed that the thoracic aortic dissection in 4 cases disappeared, and thrombogenesis was found in false lumen; the thoracic aortic dissections in 2 cases disappeared, however, a little contrast agent was found in false lumen, but the blood flow was very slow. The general condition of all patients was good with stable vital signs, all patients discharged after 7-10 days. （2）CT results at 3 month after operation suggested that the original false lumen significantly contracted, and the true lumen restored to normal level. In case 3, there was mural thrombus in the distal stent that connected with stent vessel wall, and the thr

关 键 词：主动脉夹层 带膜支架 介入治疗 

分 类 号：R543[医药卫生—心血管疾病]