腔内修复术治疗主动脉疾病:附64例报告  

Endovascular repair of aortic diseases:report of 64 cases

作　　者：师天雄[1] 胡锡祥[1] 缪健航[1] 张明光[1] 

机构地区：[1]广东省中山市人民医院普外二科,广东中山528403

出　　处：《中国普通外科杂志》2008年第12期1167-1169,共3页China Journal of General Surgery

摘　　要：目的总结主动脉疾病腔内修复治疗的初步经验。方法回顾性分析7年余64例主动脉疾病腔内修复术患者的临床资料。包括主动脉夹层42例(其中Stanford B型38例,Stanford A型4例),主动脉瘤22例。局麻或全麻下经股动脉入路植入支架型人工血管修复病变的动脉内膜。4例分别同期行血管搭桥手术(股-股动脉搭桥,锁骨下-颈总动脉搭桥,左-右颈总动脉搭桥,腹主动脉-肾动脉搭桥1例)。6例支架型人工血管一期覆盖了左锁骨下动脉而未行血管搭桥手术。结果即刻内漏18例,发生率28.12%(18/64)。无移植物错放、移位、瘤体破裂、中转手术和截瘫等并发症发生。所有受破坏的分支血管修复后真腔供血明显改善。围手术期病死率6.25%(4/64)。随访1～84(平均23.4)个月。动脉瘤组和动脉夹层组各有2例行再次手术。结论腔内修复治疗主动脉病变近期效果满意,中远期疗效有待进一步观察。Objective To explore the methods of the endovascular repair of aortic disease （aortic dissection and aortic aneurysm ）. Methods We retrospectively analysed 64cases of aortic disease treated with endovascular repair, including 42eases of aortic dissection （38 were Stanford B, 4 were Stanford A） and 22 cases of aortic aneurysms. The stent-grafts were set into the aorta cavity to cover the damaged aortic intima through the femoral artery under local or general anesthesia; 4 cases also underwent by-pass vascular operations. In 6 cases the left subclavian artery （LSA） was covered by stent-graft at the endovascular therapy without by-pass operation. Results Eighteen cases of immediate inner-leak were found after the stent placement, a rate of 28. 13 % （ 18/64 ）. No other severe complications occurred, such as stent-graft shift or error placement, aortic rupture, conversion to open-operation or paraplegia. The blood flow of all the vital branches of aorta were obviously improved. The mortality in the perioperative period was 6.25 % （4/64） ,the time of follow-up was 1 - 78 months （ mean 32 months ）. Reoperation was done in 2 cases of aortic aneurysm group and 2 cases of aortic dissection group. Conclusions The endovascular repair is a good method for aortic disease. The short and middle term result is satistactory, and the long term follow-up needs to be studied.

关 键 词：主动脉疾病/治疗 腔内修复术 移植物 

分 类 号：R654.31[医药卫生—外科学]