术后CT评价支架象鼻手术治疗慢性I型主动脉夹层的降主动脉重塑效果  

Chronic Debakey I aortic dissection in Marfan syndrome and hypertensive patients with modified stented elephant trunk surgery： a post-operative CT assessment

作　　者：赵鑫[1] 常谦[1] 朱俊明[2] 刘永民[2] 于存涛[1] 张海涛[1] 郑军[2] 李滨[1] 孙立忠[2] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心外科,100037 [2]首都医科大学附属安贞医院心外科

出　　处：《中华医学杂志》2010年第12期830-833,共4页National Medical Journal of China

基　　金：基金项目：2007首都医学发展科研基金（336）;2007北京市科技计划课题（Z07050700690715）

摘　　要：目的应用CT评价外科改良的支架象鼻技术对与马方综合征（MFS）和高血压病（HT）相关的慢性I型主动脉夹层的治疗效果。方法2003至2008年施行全主动脉弓置换＋支架象鼻手术的慢性DebakeyI型主动脉夹层患者共54例，MFS组22例，男18例，女4例，年龄（45±12）岁；HT组32例，男23例，女9例，年龄（40±9）岁。术后随访应用CT测量计算特定水平支架与主动脉、真腔与主动脉的直径比值。结果术后1年的CT结果显示，在支架中段平面两组间支架与主动脉的直径比差异无统计学意义（0．84±0．16比0．80-t-O．23，P=0．472）；全组术前与术后（0．29±O．16比0．72±0．21）及术后不同时间的直径比（0．724-0．21比0．81±0．20，0．81±O．20比0．77±0．20）差异均有统计学意义（均P≤0．001）。术后1年降主动脉支架段假腔完全血栓化的MFS组为59％，HT组为78％。结论外科改良的支架象鼻手术对与MFS和HT相关的慢性I型主动脉夹层，均可有效关闭降主动脉近段的假腔并取得良好的重塑效果。Objective To assess the outcome of stented elephant trunk surgery for chronic Debakey I aortic dissection in Marfan syndrome and hypertension patients by CT. Methods Between 2003 and 2008, 54 patients underwent the modified stented elephant trunk procedure and total arch replacement for chronic Debakey I aortic dissection. Twenty-two patients were made a diagnosis of Marfan syndrome and the other 32 patients of hypertension. Aortic evolvement was evaluated with CT angiography by calculating the diameter ratios between the stent graft/true lumen and the aorta at the same level. Results CT study one year after discharge showed no difference in the diameter ratios of the stent and aorta at the carina level between groups （0. 84 -＋0. 16 vs 0. 80 ＋0. 23, P =0. 472）, but had significant difference before and after surgery （ 0. 29 ± 0. 16 vs 0. 72± 0. 21, P ≤ 0. 001 ）. And significant difference occurred at the different periods after discharge （0.72 ±.21 vs 0.81 ±0.20, 0.81 ±0.20 vs 0.77±0.20, P≤0.001）. The residual false lumen in the proximal descending aorta reached complete thrombosis in 59% of Marfan and 78% of hypertension. Conclusion The modified stented elephant trunk technique is effective for closing the false lumen in the proximal descending aorta of chronic Debakey I aortic dissection in Marfan syndrome and hypertension patients.

关 键 词：主动脉疾病 高血压 马凡综合征 

分 类 号：R654.3[医药卫生—外科学]