肾下主动脉夹层的腔内治疗  

Endovascular treatment for infra-renal aortic dissection

作　　者：王利新[1] 符伟国[1] 郭大乔[1] 徐欣[1] 陈斌[1] 蒋俊豪[1] 杨珏[1] 史振宇[1] 竺挺[1] 董智慧[1] 石赟[1] 唐骁[1] 李玮淼[1] 王玉琦[1] 

机构地区：[1]复旦大学附属中山医院血管外科研究所,上海200032

出　　处：《外科理论与实践》2011年第2期130-132,共3页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨肾下主动脉夹层腔内修复治疗的效果与特点。方法:回顾性分析本科2004年1月至2010年11月期间15例以腔内修复为主治疗的肾下主动脉夹层。术前均通过MRA或CTA明确诊断。手术在DSA室进行,采用以腔内修复为主的方法进行治疗。病人术后1个月、3个月、6个月,以后每年于门诊进行随访。记录手术时间、出血量、总住院日数、随访时间和随访事件。结果:2例病人接受直管型移植物(支架型人工血管)植入;9例病人接受分叉型移植物植入;1例病人接受AUI型移植物植入、对侧髂动脉结扎加股-股人工血管旁路术;1例病人接受2枚直管型移植物植入、对侧髂动脉结扎加股-股人工血管旁路术;2例病人接受AUI型移植物植入,对侧髂动脉封堵器栓塞,加股-股人工血管旁路术。手术时间为(178±96)min,术中失血(152±103)mL,总住院时间为(11±5)d;随访时间(42±26)个月。1例病人6个月随访时发现存在少量内漏,随访24个月时假腔略有增大,但内漏消失;1例病人36个月时出现支架近端轻度移位,瘤腔未见扩大,未给予特殊处理;1例病人48个月时CTA检查发现股-股人工血管吻合口中度狭窄;2例病人随访半年后失访;其余10例病人随访结果满意。结论:腔内修复能有效治疗肾下主动脉夹层,具有简洁、微创的特点。远期疗效有待进一步观察。Objective To analyze the characteristics and efficacy of the endovascular treatment of infra-renal aortic dissection（IRAD）.Methods The medical records of all patients with IRAD（n= 15） treated in our department from Jan 2004 to Nov 2010 were retrospectively reviewed and analyzed.The diagnosis was confirmed by preoperative CTA or MRA check.All these patients were treated mainly with the endovascular methods.The patients were followed up mostly with CTA by the end of the 1st,3rd and 6th months;after the 1st year,once every year.The mean operation time,quantity of blood loss,hospitalization time,follow-up time and events observed were documented.Results Of these cases,2 were treated by the tube type stent-graft（SG） implantation;9 received bifurcation SG implantation;1 received AUI SG implantation,contra-lateral iliac artery ligation and femoral to femoral bypass;1 treated with two overlapping tubes type SG implantation,contralateral iliac artery ligation and femoral to femoral bypass;another 2 received AUI SG implantation,contralateral iliac artery embolization and femoral to femoral bypass.The operation time was（178±96） min;the blood loss volume was（152±103） mL;the total hospitalization time was（11±5）d.and the follow-up time was（42±26） months.Minor endoleak was found in one patient after 6 months of follow-up,and disappeared 24 months later with mild enlargement of the false lumen.Mild proximal migration of the SG was found in one patient after 36 months of follow-up;no enlargement of the false lumen was detected.Conclusions IRAD could be effectively treated by the endovascular therapy method,it is relatively simple and less invasive than the traditional open surgery.More follow-up time was needed to verify its long time effectiveness.

关 键 词：肾下主动脉夹层 支架型人工血管 腔内修复 

分 类 号：R543.16[医药卫生—心血管疾病]