限制性支架在预防及治疗Stanford B型主动脉夹层腔内修复术后远端新发破口的运用  

Application of the restrictive stent for prevent and treat of the distal redissection after endovascular repair for Stanford type B aortic dissection

作　　者：余辉[1] 马依彤[1] 袁清华[1] 马翔[1] 

机构地区：[1]新疆医科大学第一附属医院心脏中心,乌鲁木齐830054

出　　处：《新疆医科大学学报》2013年第9期1330-1333,共4页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区科技支疆项目(2013911118)

摘　　要：目的探讨限制性支架在预防及治疗Stanford B型主动脉夹层腔内修复术后远端新发破口的适应证与技术要点。方法对2011年2月-2012年10月新疆医科大学第一附属医院收治的11例腔内修复术近端锚定区不足、真腔被严重压缩及原支架远端出现新发破口的Stanford B型主动脉夹层患者的临床资料进行回顾性分析。确定第一破口位置及远端是否存在破口,在主动脉造影下预先置入限制性支架同时,在第一破口及左颈总动脉、左锁骨下动脉开口行腔内隔绝术,必要时以"烟囱"支架重建左颈总动脉的血流。术后复查主动脉CT,观察疗效以及远端新发破口、支架移位、断裂等并发症发生情况。结果手术成功率为100%,无Ⅰ型、Ⅲ型内漏发生,限制性支架内血流通畅。11例患者均存活,1例患者术后第1天出现恶心,给予保护胃黏膜治后疗症状好转。术后随访1～20个月,主动脉内支架及限制性支架位置良好,无移植物相关渗漏发生,无截瘫等并发症发生。结论限制性支架对于预防及治疗主动脉夹层腔内修复术后远端新发破口有重要作用,避免患者再次入院手术的痛苦。短期随访结果满意,远期疗效有待于进一步随访。Objective To evaluate the indications and technique points for the restrictive stent in the preven- tion and treatment of the distal redissection after endovascular repair for Stanford type B aortic dissection. Methods The clinical data of 11 patients with Stanford type B aortic dissection in our hospital from Febru- ary 2011 to October 2012 were analysed retrospectively. They all suffered from aortic dissection that have narrow distal true lumen and stent graft-induces redissection in distal part of stent-graft. After determining the location of the first redissection and the distal redissection, these patients were managed by pre-implan taring the restrictive stent combined with endovascular repair. Follow-up examinations were implemented by spiral computer tomography. Results All the Ⅱ patients were clinically successful after operation, and no patient died in the perioperative period. No Type I or Type Ⅲ endoleaks occurred. One patient felt sick in the first postoperative day, and the symptoms improved after treatment. During the follow-up study of 1--20 months postoperatively, spiral CT showed patency of all stent-grafts, enlargement of true lumen and compression of false lumen. No other complications occurred. Conclusion The restrictive stent plays an important role in the prevention and treatment of the distal redissection after endovascular repair for Stanford type B aortic dissection, which can avoid rehospitalization of patients. More cases and data are needed to evaluate the safety and efficiency of this technique.

关 键 词：STANFORD B型主动脉夹层 限制性支架 远端新发破口 预防 

分 类 号：R543.1[医药卫生—心血管疾病]