选择性覆盖左锁骨下动脉在胸主动脉腔内修复术中的应用  

Selective left subclavian artery coverage during thoracic endovascular aortic repair

作　　者：吴元兵[1] 朱云峰[1] 葛红卫[1] 朱永斌[1] 姜云飞[1] 符伟国[2] 

机构地区：[1]苏州大学附属第三医院血管外科,江苏常州213003 [2]复旦大学附属中山医院血管外科,上海200032

出　　处：《中国普通外科杂志》2012年第12期1493-1496,共4页China Journal of General Surgery

摘　　要：目的：探讨胸主动脉腔内修复术中一期覆盖左锁骨下动脉（LSA）对预后的影响。方法：回顾分析2007年6月—2012年1月76例胸主动脉病变行胸主动脉腔内修复术患者的临床资料,包括主动脉夹层56例,壁间血肿6例,胸主动脉瘤5例,外伤性胸主动脉破裂9例。腔内修复术中一期覆盖LSA 32例,部分覆盖9例,保留35例。观察疗效和并发症发生情况。结果：围手术期死亡1例（1.3%）,死于急性脑梗死。32例覆盖LSA的患者中,发生脑血管意外3例（9.4%）,左锁骨下动脉窃血1例（3.1%）,左上肢乏力4例（12.5%）,并发症发生率为25.0%（8/32）;9例部分覆盖LSA患者和35例LSA未覆盖患者中,发生脑血管意外各1例。随访3~40个月,死亡1例,I型内漏2例,均再次手术干预获得成功。结论：胸主动脉腔内修复术有选择性地一期覆盖左锁骨下动脉是可行的。Objective： To investigate the prognostic impact of coverage of the left subclavian artery （LSA） without prior revascularization during thoracic endovascular aortic repair （TEVAR）. Methods： The clinical data of 76 patients with thoracic lesions undergoing TEVAR between June 2007 and January 2012 were retrospectively analyzed. The lesions comprised aortic dissection （56 cases）, intramural hematoma （6 cases）, thoracic aneurysm（5 cases） and traumatic rupture of the thoracic aorta （9 cases）. Of the patients, 32 cases underwent TEVAR with complete LSA coverage, 9 cases with partial LSA coverage and 35 cases without LSA coverage. Xhe clinical outcomes and complications of the patients were analyzed. Results： One patient （1.3%） died of acute stroke during perioperative period. Of the 32 patients with LSA coverage, cerebrovascular accident occurred in 3 cases （9.4%）, left upper extremity claudication developed in 4 patients （12.5%） and left subclavian steal syndrome appeared in one case （3.1%）. The follow-up ranged from 3 to 40 months, during which one patient died, and type I endoleak occurred in 2 patients and was resolved by a second surgical intervention. Conclusion- Selective primary LSA coverage during TEVAR is practicable.

关 键 词：主动脉 胸 主动脉疾病 腔内治疗 左锁骨下动脉 

分 类 号：R654.3[医药卫生—外科学]