主动脉夹层TEVAR术后远端破口的临床分型及手术时机的选择  

Clinical classifications and surgical timing of romote crevasse in aor- tic dissection after operation by TEVAR

作　　者：戈小虎[1] 管圣[1] 方青波[1] 阿力木江[1] 赛力木[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：《国际外科学杂志》2012年第12期814-816,共3页International Journal of Surgery

摘　　要：目的探讨主动脉夹层TEVAR术后远端破口的治疗方法。方法对新疆维吾尔自治区人民医院血管外科2006年1月－2012年4月168例行TEVAR的StamfordB型主动脉夹层患者的病例资料进行同顾性分析，根据远端破口位置的不同将其分为4划：Ⅰ型：破口位于支架尾部；Ⅱ型：破口位于胸腹主动脉，距离内脏动脉较近或累及内脏动脉；Ⅲ型：破口位于肾下腹主动脉，破口未累及内脏动脉；Ⅳ型：破口位于髂动脉。据此分型标准，对主动脉夹层TEVAR术后发生远端破口的82例患者制定相应的治疗策略并决定手术时机。结果有82例患者支架远端仍有破口，临床分型为Ⅰ型：12例出现支架尾部破口，均行支架远端破口腔内隔绝术；Ⅱ型：47例破口位丁腹主动脉并累计内脏动脉，经随访，其中4例在随访中发现假腔持续扩大或伴有症状，行“杂交”手术，即先行内脏动脉重建（髂动脉－双肾动脉，髂动脉－肠系膜上动脉，髂动脉－腹腔干人工血管搭桥术），二期行胸腹主动脉腔内隔绝术。43例患者随访发现假腔无扩大，目前继续随访。Ⅲ型：13例破口位于肾下腹主动脉，均行腔内隔绝术。Ⅳ型：10例破口位于髂动脉，均行腔内隔绝术。术后围手术期无死亡。82例患者获得随访，随访时间10～36个月，平均随访时问（25．6±8．4）个月，在随访过程中未发现并发症。结论对于TEVAR术后远端破口，应根据个体情况，结合临床分型选择适宜的手术时机和于术方式，从而达到满意的治疗效果。Objective To explore the treatment methods of romote erevasse in aortic dissection after operation by TEVAR. Method The information on the treatment of 168 patients with stanfford B aortic dissection were retrospectively analyzed, of the Department of Vascular Center, People＇ s Hospital of Xinjiang Uygur Autonomous Region from January 2006 to April 2012. According to the location, the crevasse can be divided into four types： I type： the erevasse in the bracket tail, II type： the crevasse in the thoracic and abdominal aorta, near or involving the visceral arteries, III type： the crevasse in the infrarenal abdominal aorta, without visceral arteries involvement. IV type： the crevasse in the lilac artery. Under this standard,we formulated corresponding treatment strategies and the timing of surgery for 82 patients with romote crevasse after operation by TEVAR. Result Eighty-two patients had remote crevasse,in which type I 12 cases were were surgery by Endovascular repair; type II 47 cases, 4 of which were found in the tollow-up the false lumen continues to expand or associated symptoms, They were cured by the ＂hybrid＂ surgery, （First, to reconstruct the visceral arteries：iliac artery -renal artery, iliac artery-the superior mesenterie artery and iliac arteries -the celiac axis the artificial vascular bypass surgery, Secondly with thoracoab- dominal aortic repair） ; 43 patients were followed up without expanding, and continue to follow-up; type III 13 cases were cured by Endovascular repair; type IV 10 cases were cured by Endovascular repair, there was no deaths and complications in 82 patients who were followed up between 10 and 36 months, with an average follow-up time （25.6 ± 8.4） months. Conclusion According to individual characteristics and combining with the clinical classi- fication, we can select the appropriate surgery time and surgical approaches for the patients with remote crevasses after operation by TEVAR, so as to achieve a satisfactory therapeutic effect.

关 键 词：主动脉夹层 腔内胸主动脉修复 远端破口 临床分型 

分 类 号：R654.3[医药卫生—外科学]