Stanford B型主动脉夹层腔内修复术后中远期并发症分析  

The mid-to long-term complications of endovascular repair for Stanford type B aortic dissection

作　　者：常光其[1] 李梓伦[1] 姚陈[1] 殷恒讳[1] 李松奇[1] 李晓曦[1] 王劲松[1] 胡作军[1] 王冕[1] 王深明[1] 

机构地区：[1]中山大学附属第一医院血管外科,广州510080

出　　处：《中华普通外科杂志》2013年第12期908-910,共3页Chinese Journal of General Surgery

摘　　要：目的总结StanfordB型主动脉夹层（TB—AD）腔内修复术中远期并发症的治疗经验。方法对2001年1月至2013年5月因TB—AD在中山大学附属第一医院进行血管腔内修复术（thoracic endovascular aortic repair，TEVAR）的能够进行全程随访的156例患者资料进行回顾性分析。结果156例患者TEVAR手术均获成功，成功率100％。封堵左锁骨下动脉（left subclavian artery，LSA）32例，烟囱支架重建LSA8例；封堵左颈总动脉（left common carotid artery，LCCA）1例，烟囱支架重建LCCA1例。术后内漏25例（16．0％），脑梗死4例（2．6％），入路并发症5例（3．2％），住院30d死亡5例（3．2％）。平均随访（49±42）个月，随访期间死亡12例（8．8％），其中9例死因与夹层相关；旁路吻合口瘘／假性动脉瘤1例（0．6％），夹层逆行撕裂1例（0．6％），穿刺入路侧下肢缺血2例（1．3％）。二次腔内手术4例（2．6％），1个月内漏6例（3．9％）。结论TB—AD腔内修复术中远期随访结果满意，夹层破裂为导致死亡最严重的中远期并发症，密切随访可早发现和处理其潜在的危险因素。Objective To analyze the mid- to long-term complications of endovascular repair for Stanford type B aortic dissection （TB-AD）. Methods Data of 156 consecutive TB-AD patients treated by thoracic endovascular aortic repair （TEVAR） in our center from January 2001 to May 2013 were analyzed retrospectively. Results Technical success was achieved in all cases. Left subclavian artery （LSA） was covered in 32 cases, and reconstructed by chimney graft in 8 cases. Left common carotid artery （LCCA） was covered in 1 case and reconstructed by chimney graft in 1 case. Postoperative endoleak, stroke, access complication, and in-hospital 30-day mortality were observed in 25 （ 16. 0% ）, 4 （2. 6% ） , 5 （3.2%）, and 5 （3.2%） cases, respectively. During the follow-up of （49 -42） months, there were 12 （8.8%） deaths, including 9 dying of aortic dissection. There was 1 bypass anastomotic fistula/pseudoaneurysm, 1 stent-graft induced retrograde type A dissection, and 2 of lower limb ischemia secondary to femoral artery access. Re-intervention was performed in 4 cases （2. 6% ） , and within 1-month endoleak was observed in 6 cases （3.9%）. Conclusions The mid-to long-term result of endovascular repair for TB-AD are satisfactory. Rupture of aortic dissection is the most serious mid-to long-term complication. Intensive follow- up is needed to detect and manage the potential risk factors.

关 键 词：手术后并发症 血管成形术 主动脉夹层 

分 类 号：R654.3[医药卫生—外科学]