Stanford B型主动脉夹层的腔内治疗  

Endovascular repair for type B aortic dissection

作　　者：戈小虎[1] 方青波[1] 管圣[1] 赛里木[1] 任昊[1] 

机构地区：[1]新疆维吾尔自治区人民医院血管外科,乌鲁木齐830001

出　　处：《中华普通外科杂志》2011年第11期907-909,共3页Chinese Journal of General Surgery

摘　　要：目的探讨腔内胸主动脉修复术治疗StanfordB型夹层的临床价值。方法回顾性分析2006年1月至2011年4月126例行腔内胸主动脉修复术的B型主动脉夹层患者的临床资料，其中男86例，女40例；年龄32～82岁，平均（56±8）岁。在数字减影血管造影（digital subtraction angiography，DSA）监控下，切开股动脉，将带膜支架置于胸主动脉内膜破口处，封堵破口。术后影像学随访观察有无内漏、移位和支架塌陷等术后并发症。结果126例手术成功，释放支架157枚。所有患者原发胸主动脉夹层破口完全封闭，真腔血流恢复，受损脏器功能恢复正常。术后82例患者获得随访，随访率65％，随访时间3—63个月，平均随访时间（26±8）个月。复查显示无内漏、移位等并发症，围手术期死亡2例，随访死亡1例，12例出现支架尾部破口，再次行腔内隔绝，1例术后出现逆行性A型夹层。结论腔内胸主动脉修复术是治疗StanfordB型夹层具有技术可靠，安全性高，术后恢复快等优点。Objective To evaluate thoracic endovascular aortic repair for type B aortic dissection. Methods Clinical data were reviewed on 126 cases with type B aortic dissection undergoing endovascular aortic repair in our hospital from January 2006 to April 2011. There were 86 male patients and 40 female patients, age from 32 to 82 years. The stent-grafts were introduced via femoral arteriotomy. Stent-grafts were implanted to blockade tears of aortic dissection under the guidance of DSA. Postoperatively patients were followed-up by angiography and imiging for endoleak, stent migration, and fracture of stent-graft. Results In all cases, the aortic dissection tears were closed, true lumens were opened, and organ function was restored. There were not complications such as internal hemorrhage due to trauma or stent displacement on CTA from 3 to 63 months after endovascular therapy. Procedure was successful in all 126 cases, 157 stents were released, 2 cases died in the perioperative period, 1 case died during the followed-up. A breach was found at the end of the stent in 12 cases, endovascular aortic repair redone successfully with a retrograde type A dissection found during follow-up. Conclusions Endovascular aortic repair is safe and effective for patients with Stanford type B aortic dissection with a favorable outcomes.

关 键 词：动脉瘤 夹层 主动脉瘤 胸 支架 腔内隔绝 

分 类 号：R654.3[医药卫生—外科学]