旋转DSA及三维重建在“一站式”手术治疗Stanford B型主动脉夹层合并冠心病中的价值和运用  

Clinical application of rotational 3D-DSA in "One-stop" operation for aortic dissection with coronary artery disease

作　　者：阚静[1] 陈绍良[1] 朱建成[1] 林玲[1] 徐海梅[1] 赵莹莹[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院),南京210006

出　　处：《现代仪器》2012年第3期51-54,共4页Modern Instruments

摘　　要：目的探讨旋转DSA及三维重建在经皮冠状动脉腔内成形术和覆膜支架腔内隔绝术"一站式"手术方式治疗Stanford B型主动脉夹层合并冠心病患者的临床运用和价值。方法 2008年11月至2011年11月,121例,平均年龄(56±12)岁的Stanford B型主动脉夹层患者,48例合并冠心病进行冠状动脉造影,主动脉旋转DSA及三维重建,其中15例同期进行经皮冠状动脉腔内成形术和覆膜支架腔内隔绝术"一站式"手术。先在常规局麻下,完成冠状动脉造影,主动脉造影和冠状动脉支架术,再在全麻下行覆膜支架腔内隔绝术。结果 121例Stanford B型AD患者均成功植入主动脉腔内覆膜支架,完全覆盖夹层破口。15例接受冠状动脉支架术,冠状动脉支架完全覆盖病变,术后即刻残余狭窄<20%,TIMI血流3级。术后3例脑梗塞,4例死亡。平均术后(15±9)天出院。术后随访5-12个月,平均(10.67±2.65)个月,117例患者均健康生存,无脏器功能不全。结论运用旋转DSA及三维重建技术进行经皮冠状动脉腔内成形术和覆膜支架腔内隔绝术"一站式"手术,简化Stanford B型主动脉夹层合并冠心病患者手术程序,提高手术精确性,减少手术周期,加快病人术后康复。Objective： To investigate the clinical application of rotational three-dimensional digital subtraction angiography（3D-DSA） in ＂one-stop＂ operation for Stanford B type aortic dissection with coronary artery disease.The procedure consisted of coronary artery angiography,aortography,percutaneous coronary intervention and endovascular graft exclusion.Methods： From November 2008 to November 2011,121 patients [mean age（56±12）years] who had Stanford B type aortic dissection.3D-DSA was employed for 48 patients who combine with coronary artery disease,of the 15 cases underwent coronary artery stenting at the same time.The aortography,coronary artery angiography and stenting were performed via the Right radial artery under local anesthesia.Finally the endovascular stent grafts were deployed via the femoral incisions monitored dynamically with DSA under general anesthesia.Results： The operation succeeded in all 121 patients.The endovascular stent grafts completely covered lacerations.the coronary artery stenting in 15 patients.The coronary stents were completely covered lesions,and residual stenosis 〈20%,TIMI flow 3 grade.3 patiens underwent cerebral infarction post procedure,and 4 patients were died in hospital.The duration of hospitalization was（15±9） days in 117 patients occurred.Patients were followed up for 5-12 months [meun（10.67±2.65）months].All patients survived without any organ dysfunction at follow up.Conclusion： Our findings indicated that the rotational 3D-DSA in ＂one-stop＂ operation,may be an option for Stanford B type aortic dissection with coronary artery disease.The ＂one-stop＂ operation improve the outcomes and provide a simplified approach for the treatment Stanford B type aortic dissection with coronary artery disease.

关 键 词：主动脉夹层 冠心病 DSA 三维重建 覆膜支架腔内隔绝术 

分 类 号：R543.1[医药卫生—心血管疾病] R540.46[医药卫生—内科学]