胸主动脉腔内修复术封堵左锁骨下动脉的前瞻性研究  

Prospective study of coverage of left subclavian artery during thoracic endovascular aortic repair in a single center

作　　者：司逸[1] 符伟国[1] 王玉琦[1] 徐欣[1] 郭大乔[1] 陈斌[1] 蒋俊豪[1] 杨珏[1] 史振宇[1] 竺挺[1] 石赟[1] 董智慧[1] 

机构地区：[1]复旦大学附属中山医院血管外科,上海200032

出　　处：《中华外科杂志》2009年第24期1868-1872,共5页Chinese Journal of Surgery

基　　金：基金项目：上海市科委优秀学科带头人计划资助项目（08XD14012）

摘　　要：目的探讨胸主动脉腔内修复术（TEVAR）封堵左锁骨下动脉的安全性和可行性。方法2007年12月至2008年12月共111例胸主动脉病变患者进入本研究。根据术中封堵左锁骨下动脉的情况分为完全封堵、封堵〈50％、封堵〉50％和未封堵组。术前及术后第1、3、5和30天随访测量患者双上肢的血压差值，同时评估有无脑卒中、偏瘫和截瘫以及左上肢缺血等情况。结果完全封堵55例（49．6％），封堵〈50％18例（16．2％），封堵〉50％7例（6．3％），未封堵31例（27．9％）。所有患者TEVAR均成功，无脑卒中、截瘫及偏瘫发生。完全封堵组与其余3组相比，双上肢血压差值的差异有统计学意义（P〈0．01）。术后1周内完全封堵组中13例出现与左上肢活动无关的头晕，其中5例伴黑礞；7例出现左上肢间歇性跛行症状。结论TEVAR中，为延长近端锚定区对左锁骨下动脉的封堵是安全可行的，但在某些情况下应行血管重建，以提供更为持久的修复效果。Objective To describe observation of security and availability of covering left subclavian artery during thoracic endovascular aortic repair （TEVAR） in follow-up. Methods From December 2007 to December 2008, 111 consecutive patients received stent grafts to treat lesions involving thoracic aorta. According to the covering of left subclavian artery, four groups including total covering （TC）, less-than 50% covering （LTC）, more-than 50% covering （MTC） and non-covering （NC） were formed. Difference of blood pressure between two upper extremities was required before TEVAR and 1^st, 3^rd, 5^th, 30^th day after TEVAR. Patients were evaluated postoperatively and at follow-up for stroke as well as symptoms of paraplegia, hemiparalysis or left upper extremity claudication. Results Fifty-five （49. 6% ）, 18（16.2%）, 7（6.3%） and 31 （27.9%） cases were divided into TC, LTC, MTC and NC groups, respectively. Difference of blood pressure between TC and the 3 latter groups were significantly different （P 〈0.01 ）. Complications appeared as followed during one week after TEVAR： 13 patients in dizziness, among which 5 patients suffered from amaurosis and spotted vision, and 7 patients in left upper extremity claudication. No stroke, paraplegia or hemiparalysis in TC. Thoracic aortic lesions were successfully excluded in all patients. Conclusions Intentional coverage of left subclavian artery to obtain an adequate proximal landing zone during TEVAR is safe and well-tolerated. But it may be managed expectantly with some exceptions for futher lasting efficacy.

关 键 词：主动脉瘤 胸 假体和植入物 锁骨下动脉 

分 类 号：R686[医药卫生—骨科学]