Stanford B型主动脉夹层发病24h内腔内修复术30例  

Endovascular stent-grafts for acute Stanford type B aortic dissection

作　　者：汤敬东[1] 黄俊峰[1] 左克强[1] 钱振宇[1] 杭闻曌[1] 龚凯[1] 黄道景[1] 吴春红[1] 张文艳[1] 杨明烽[1] 景在平[2] 王玉琦[3] 

机构地区：[1]上海同济大学附属同济医院血管外科,200065 [2]第二军医大学附属长海医院,上海 [3]复旦大学附属中山医院血管外科 ,上海

出　　处：《中华普通外科杂志》2010年第3期221-223,共3页Chinese Journal of General Surgery

基　　金：国家自然科学基金资助项目（30600609）

摘　　要：目的探讨Stanford B型主动脉夹层（aortic dissection，AD）发病24h内腔内修复术的疗效。方法回顾性分析2007年6月至2008年10月急诊行腔内修复Stanford B型主动脉夹层30例的临床资料。本组腔内修复术均在胸痛症状出现后24h内完成；采用全身麻醉，在X线透视下将覆膜支架经股动脉放置在夹层第1裂口位置；其中1例第1裂口位于腹腔干对侧缘，运用开窗支架技术实施腔内修复术。术后1周、1、3、6、12个月行螺旋CT检查，观察手术疗效以及有无内漏、支架移位和内脏血供等。结果30例支架均成功释放，无支架移位，无中转开胸手术，即刻造影Ⅰ型内漏4例（13．4％），近端球囊扩张后3例消失，1例小于10％；所有患者真腔供血均得到改善。术后30d死亡1例（3．3％），可能缘于术后夹层破裂；30例术后随访1～19个月，平均（12±8）个月，术后6个月发现1例（3．3％）Ⅰ型内漏；无其他新发内漏出现。随访期间死亡1例（3．3％），该患者术后2月出现急性肝功能衰竭，死因不明。结论24h内腔内修复Stanford B型主动脉夹层可明显降低急性起病期患者死亡率，但远期效果还有待进一步观察。Objective To assess the results of emergency endovascular stent-grafting for patients with acute Stanford type B aortic dissection （type B AAD） within 24 hours of onset. Methods Between June 2007 and October 2008, 30 patients with acute type B aortic dissection underwent emergency endovascular stent-grafting within 24 hours of presentation. Under general anesthesia, stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray monitering. Follow-up by CT was performed 1 w, 1 m,3 m,6 m, 1 y postoperatively to observe the efficacy and complications such as endoleak, migration and fracture of stent-graft. Result The technical success rate was 100% ; 13.4% （4 cases） endoleak rate was identified immediately after deployment. Follow up was made between 1 month to 19 months, averaging at （ 12 ± 8） months, 3.3% type-1 endoleak was observed after 6 months; One patient died within 30 days possibly of dissection rupture; One patient died of acute liver failure during the follow-up. Conclusion Endovascular repair with stent-graft within 24 hours of presentation was effective for the treatment of acute type B aortic dissection.

关 键 词：动脉瘤 夹层 支架 急性期 

分 类 号：R543.1[医药卫生—心血管疾病]