应用烟囱技术治疗锚定区不足的主动脉弓部病变11例临床分析  

The application of chimney graft technique for TEVAR of Debakey Ⅲ type aortic dissection in 11 cases

作　　者：张岳[1] 马依彤[1] 赵龙[1] 余辉[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8期1125-1130,共6页Journal of Xinjiang Medical University

基　　金：新疆科技支疆项目(2013911118)

摘　　要：目的探讨“烟囱”技术在主动脉腔内修复术中的临床效果。方法回顾性分析2010年6月-2012年10月应用“烟囱”技术处理主动脉弓部病变的11例患者的方法、结果和术后并发症发生率等。结果左侧颈总动脉植入“烟囱”支架7例，左侧锁骨下动脉植入“烟囱”支架4例。1例术后即刻造影提示存在少量I型内漏，1例患者术后出现运动性失语，2例封闭左锁骨下动脉的患者术后出现左上肢无力症状。随访时间5～32个月，术后出现运动性失语的患者术后1个月复查时已完全恢复语言能力。2例左上肢无力患者随访过程中逐渐恢复，无肢体缺血坏死。5例患者术后3个月随访胸腔积液完全消失。1例术后有I型内漏的患者3个月后复查内漏消失。其余患者随访主动脉CTA未发现新增内漏，“烟囱”支架均通畅，降主动脉真腔直径显著扩大，假腔直径逐渐缩小，无大动脉支架和“烟囱”支架移位等并发症。结论“烟囱”技术通过完全腔内方法重修分支血管，对于近端锚定区不足的Debakey Ⅲ型主动脉夹层提供了微创腔内治疗的机会。短期随访结果满意。但本组病例较少，长期疗效还需进一步随访。Objective To investigate the safety and efficacy of endovascular aortic repair by chimney tech-nique in DeBakey Ⅲ type aortic dissection .Methods Review and analyze the methods ,results and the in-cidence of complications in 11 cases implanted by chimney stent into the branch vessels .Results A total of 11 cases （8 males and 3 females ,aged 39-79） with aortic lesions were enrolled for the endovascular repair from June 2010 to October 2012 .The chimney technique was used for the left common carotid artery in seven cases and for the left subclavian artery in 4 cases .Only two cases suggested the presence of small amount of type 1 endoleak by immediate postoperative angiography .During the follow up ,post stenting , the diameter of the descending aorta true lumen significantly expanded ,w hile the diameter of the false lu-men gradually narrowed .No chimney stent migration and/or other concurrent diseases were identified . Conclusion T he“chimney” technique for endovascular repair of Debakey Ⅲ type aortic dissection is safe and effective .It is a new way for expansion of the anchoring zone .

关 键 词：腔内隔绝术 烟囱技术 主动脉夹层 主动脉瘤 

分 类 号：R654.3[医药卫生—外科学]