腔内隔绝治疗特殊类型主动脉夹层动脉瘤和复杂型腹主动脉瘤  

Clinical analysis of special type aortic dissection aneurysm and complicated type abdominal aortic aneurysm with the treatment of endovascular stent-graft exclusion

作　　者：林少芒[1] 张智辉[1] 陈德基[1] 申刚[1] 萧剑彬[1] 曹良启[1] 

机构地区：[1]广州医学院第二附属医院血管外科,510260

出　　处：《中华普通外科学文献（电子版）》2010年第6期29-31,共3页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2008B060600047)

摘　　要：目的探讨基底节区脑出血合并StanfordB型主动脉夹层动脉瘤、肾移植术后患者合并StanfordB型主动脉夹层动脉瘤以及复杂型腹主动脉瘤进行腔内隔绝术的可行性。方法对4例特殊类型的动脉瘤行腔内隔绝治疗,1例为基底节区脑出血合并StanfordB型主动脉夹层动脉瘤,1例为肾移植术后合并StanfordB型主动脉夹层动脉瘤,2例为瘤颈成角大于70°,瘤颈长1.6cm,髂动脉严重扭曲。结果 2例主动脉夹层动脉瘤患者术后未发生内漏,术中应用小剂量肝素,减少造影剂,建立稳定的低血压,有效地保证了脑和移植肾血流灌注,防止了脑部再出血和移植肾的功能损害;2例腹主动脉瘤患者,通过拉紧两端导丝克服血管扭曲的方法使带膜支架顺利释放,带膜支架成角严重时在成角处加放裸支架。其中1例瘤颈发生内漏,支架0.4cm移位,降压治疗1周后复查螺旋CT血管成像(CTA)内漏基本消失,1例髂外动脉带膜支架成角未及时加放裸支架,术后因成角处血流缓慢出现血栓形成,急诊行股—股搭桥。4例患者均痊愈出院。结论应用腔内隔绝治疗脑出血和肾移植后合并主动脉夹层动脉瘤、复杂型腹主动脉瘤是可行的。Objective To investigate the clinical feasibility of basal ganglion intracerebral hemorrhage, postopratiive rehabilitation of renal transplantation combined with Standford B type aortic dissection aneurysm （ADA）, and complicated type abdominal aortic aneurysm （AAA） with the treatment of endovascular stent-graft exelusion（EVGE）. Methods 4 cases of aneurysms were reported： one case was a patient with basal ganglion intracerebral hemorrhage combined with Standford B type aortic dissection aneurysm, one was the postopratiive rehabilitation of renal transplantation combined with Standford B type aortic dissection aneurysm, and the other two cases were the complicated type AAA, which characterized as an over-70° degree corner formed by tumor neck, the length of tumor neck being 1.6 cm, and severe tortuous iliac artery. The EVGE was used to treat these type diseases. Results Internal hemorrhage was not found in the two cases of ADA, since low-dose heparin, reduced contrast medium, and maintained stable low blood pressure were construced in the operation, which ensured the blood perfusion and prevented their functional lesion from brain and kidney. As far as two AAA were concerned, the vascular stent was smoothly released by guide wire-righted tortuous artery, nude stent was added to place at the formed comer to avoid thrombsis. Unfortunately, one of them produced internal leak and stent displace. The treatment for the condition was to lower blood pressure and reduced leak. The other produced the thrombus at the formed comer, whose treatment was urgent operation bypass grafting. Finally, the 4 cases of patients were discharged healthily. Conclusions Basal ganglion intracerebral hemorrhage, postopratiive rehabilitation of renal transplantation combined with Standford B type ADA, and complicated type AAA with the treatment of EVGE is feasible.

关 键 词：主动脉夹层动脉瘤 腹主动脉瘤 腔内隔绝术 脑出血 肾移植 

分 类 号：R654.3[医药卫生—外科学]