主动脉夹层覆膜支架腔内修复术后并发症  

Complications following transluminal stent-graft placement for aortic dissections

作　　者：禹纪红[1] 黄连军[2] 蒋世良[1] 金敬琳[1] 吕滨[1] 常宗平[1] 

机构地区：[1]北京阜外心血管病医院心血管病研究所放射科,北京100037 [2]首都医科大学附属安贞医院放射科,北京100029

出　　处：《当代医学》2009年第29期532-535,共4页Contemporary Medicine

摘　　要：目的总结覆膜支架腔内修复术治疗主动脉夹层的经验,分析、探讨各种并发症发生的原因及处理方法。方法2002年4月至2009年1月,346例连续性覆膜支架腔内修复术的降主动脉夹层患者,包括B型夹层303例,B型主动脉穿通性溃疡(不典型夹层)39例,A型夹层术后并发症4例;男性304例,女性42例;平均年龄50.6岁。术后1个月、6个月、12个月及每年行CTA影像随访。统计不同时间段的并发症,计算其发生率及死亡率,按各并发症的发生与否分组进行logistic回归分析,探讨其发生的影响因素。结果术中无死亡,技术成功率99.7%。围手术期主要并发症率及死亡率分别为2.6%和1.7%。随访31.3±23.7月,并发症率及死亡率分别为4.6%为2.1%。主要并发症包括逆行型A型夹层(n=5)、支架一端新破口形成(n=13)、缺血性脑卒中(n=2)等。内漏的总发生率21.4%,随访中59.5%消失。结论尽管主动脉夹层覆膜支架腔内修复术治疗B型主动脉夹层疗效显著,但严重并发症不容忽视。Objective： To update our experience with transluminal stent-graft placement （TSGP） for aortic dissections （AD） over a 6-year period, focusing on the occurrence and management of serious complications. Methods： From April 2002 to January 2009, 346 consecutive patients underwent TSGP for aortic dissection, which included 303 B type aortic dissections, 39 penetrating aortic ulcers, and 4 postoperative complications of A type aortic dissections. There were 304 men and 42 women with mean age 50.6 years. All complications occurring during different periods were recorded. Results： The 30-day morbidity and mortality were 2.6% and 1.7% respectively. The mean follow-up period was 31.3 ＋ 23.7 months. Late morbidity and mortality were 4.6% and 2.1%. Serious complications included retrograde type A dissection （n=5）, new tears at the end of stent （n=l 3）, Stroke （n=2）, et al. Overall, endoleak rate was 21.4%, 59.5% of which disappeared lately. Multivariate analyses by stepwise logistic regression identified the size of entry tear and the maximum diameter of thoracic false lumen as predictors of endoleak. The independent determinants of new tears at the end of stent were the size of stent. Conclusion： Although the morbidity and mortality of TSGP for descending aortic dissection is well acceptable, the serious complications threaten the patient lives and ought to be paid more attentions.

关 键 词：B型主动脉夹层 腔内修复术 逆行性A型夹层 内漏 

分 类 号：R543.1[医药卫生—心血管疾病]