“烟囱”技术在治疗累及主动脉弓分支动脉的Stanford B型主动脉夹层中的应用  

Endovascular aortic repair plus chimney technique in the treatment of Stanford type B aortic dissection involving aortic arch

作　　者：舒畅[1] 王暾[1] 黎明[1] 李鑫[1] 李全明[1] 方坤[1] 

机构地区：[1]中南大学湘雅二医院血管外科,长沙410011

出　　处：《中华医学杂志》2012年第47期3320-3323,共4页National Medical Journal of China

摘　　要：目的探讨“烟囱”技术在累及主动脉弓部分支动脉的StanfordB型夹层的治疗作用。方法对2009年6月至2012年3月中南大学湘雅二医院血管外科采用“烟囱”技术治疗的第一破口邻近主动脉弓部分支动脉起始端的32例Stanford B型主动脉夹层患者进行回顾性研究。“烟囱”技术重建左锁骨下动脉2例，重建左颈总动脉28例，采用“双烟囱”技术同时重建无名动脉和左颈总动脉2例。结果急诊手术4例。手术成功率100％，无I型内漏发生。4例发生左锁骨下动脉Ⅱ型内漏，3例采用PDA封堵器封堵内漏，1例合并Maffan综合征和妊高症，予以保守治疗，11个月后内漏消失。随访时间（144-7）个月。未发现截瘫、脑卒中、左锁骨下动脉缺血等并发症。主动脉和分支动脉内覆膜支架位置均良好，“烟囱”支架均保持通畅。结论采用“烟囱”技术的胸主动脉腔内修复术，是治疗第一破口邻近主动脉弓部分支动脉起始端的StanfordB型主动脉夹层安全、有效的方法。中期随访结果满意．远期疗效还需要进一步研究。Objective To evaluate the efficacy of endovascular aortic repair plus chimney technique in the treatment of Stanford type B aortic dissection involving aortic arch. Methods From June 2009 to March 2012, 32 patients of aortic arch dissection with primary entry tear next to the orifices of supra-aortic arteries were treated with chimney technique. Chimney technique was used to reconstruct left subclavian artery （n = 2 ） and left common carotid artery （n = 28 ）. Double chimney technique was use to reconstruct innominate artery and left common carotid artery simultaneously in 2 patients. Results Four patients received emergency operation. All patients survived and were followed up for 14. 3 -＋7.4 months. No type I endoleak occurred. Among 4 patients with Type 11 endoleak, 3 received PDA occluding implantation in left subclavian artery and 1 patient in puerperium with Marfan syndrome and pregnancy-induced hypertension syndrome recovered by conservative treatment. No severe neurological complications and left subclavian artery isehemia occurred. The locations of aortic and chimney stent-grafts were stable without any migration. All stent-grafts remained patent. Conclusion Endovascular aortic repair plus chimney technique is a safe and effective treatment for Stanford type B aortic dissection involving aortic arch.

关 键 词：动脉瘤 夹层 主动脉 胸 人工血管 支架 

分 类 号：R654.3[医药卫生—外科学]