腔内隔绝术治疗B型主动脉夹层的临床分析  

Clinical Analysis of Endovascular Graft Exclusion for the Treatment of Stanford Type B Aortic Dissection

作　　者：周中新[1] 黄继江[1] 武维衡[1] 储伟[1] 邱忠进[1] 曾万里[1] 王欢欢[1] 

机构地区：[1]徐州医学院第二附属医院心胸外科,江苏省徐州市221006

出　　处：《中华全科医学》2010年第12期1516-1518,共3页Chinese Journal of General Practice

摘　　要：目的探讨腔内隔绝术治疗B型主动脉夹层临床疗效和面临的挑战与对策。方法 35例B型主动脉夹层患者,男性27例,女性8例,平均年龄(61.2±9.7)岁。术前行超声心动图、CT、MRI、MSCT检查,介入治疗过程均在DSA监视下完成。选用大动脉覆膜血管内支架封堵夹层原发破口。随访采用X线胸片和EBCT检查。结果腔内隔绝治疗全部成功,术后即刻造影无内漏。降主动脉及腹主动脉真腔均明显扩大,远端降主动脉及分支供血均有不同程度的改善。术后发生左下肢偏瘫1例,股动脉切口淋巴漏1例,间断胸痛2例。封堵了左锁骨下动脉的3例患者中,术后有1例诉有头晕症状,伴有左上肢肌力减退、脉搏减弱、活动后酸痛等症状,术后2周行升主动脉-左锁骨下动脉旁路移植术,症状逐渐缓解。结论腔内隔绝术治疗B型主动脉夹层安全有效,近、中期疗效满意。Objective To investigate the clinical effectiveness,challenge and strategy of endovascular stent-graft placement for the treatment of Stanford type B aortic dissection. Methods 35 patients with type B aortic dissection were treated with endovas- cular stent-grafis placement,27 males and 8 females with average age of 61.2 ± 9.7. All patients had undergone ultrasonic cardiogram（ UCG）, CT or MRI scans. Vascular access was obtained according to cuting the femoral artery. Follow-up X-ray and EBCT were performed. Results Stent-graft deployment was performed successfully. Immediate postoperative aorto-ngiography showed no leakage. The diameters in thoracic aorta the true lumen at different levels were increased significantly. Improvements of the blood flow in the distal descending aorta and abdominal branch-vessels were all achieved alleviation gradually. Endovascular stent-graft deployment was postoperative left lower limb paralysis in 1 case, femoral artery incision lymphatic leakage in 1 case,2 cases of intermittent chest pain. Sealing off the left subclavian artery in 3 patients, 1 patient complained of postoperative symptoms of dizziness, associated with left upper limb weakness, weakened pulse, pain and other symptoms after the event. Two weeks after surgery of ascending aorta-left subclavian artery bypass grafting, the symptoms were relieved. Conclusion It was an effective method for the treatment of type B aortic dissections.

关 键 词：覆膜血管内支架 腔内隔绝术 STANFORD B型 主动脉夹层 

分 类 号：R654.31[医药卫生—外科学] R543.1[医药卫生—临床医学]