介入腔内覆膜支架植入术治疗主动脉穿通性溃疡的早中期结果分析  

Analysis of early and mid-term results of thoracic endovascular aortic repair of penetrating atherosclerotic aortic ulcers

作　　者：熊文龙[1] 魏以桢[1] 韩超[1] 于存涛[1] 钱向阳[1] 孙晓刚[1] 常谦[1] 

机构地区：[1]中国医学科学院阜外心血管病医院血管外科中心,北京100037

出　　处：《中国医师杂志》2014年第1期93-95,99,共4页Journal of Chinese Physician

摘　　要：目的 探讨介入腔内覆膜支架植入术（TEVAR）治疗主动脉穿通性溃疡（PAU）的临床疗效及中期结果.方法 回顾性分析2009年5月至2013年5月36例采用TEVAR治疗的PAU患者的临床资料及随访结果.结果 36例患者中男27例（75%）,女9例（25%）,年龄41～79（59.5＆#177;8.7）岁,29例（80.6%）入院时有急性主动脉综合征的典型疼痛症状.所有患者均通过主动脉增强CT确诊为PAU并择期手术植入覆膜支架.手术成功率100%,30例患者进入术后恢复室进行观察,时间3～63（16.43＆#177;14.69）h,术后住院时间4～14（6.78＆#177;2.11）d;1例术后第6天夜突发脑梗死.所有患者均进行随访,随访时间3～52（22.5＆#177;15.5）个月,2例发生脑梗死,其中1例术后33个月死亡.2例术后CT发现微量Ⅱ型内漏,3个月后复查消失;其余患者术后及复查CT显示支架贴壁良好,无位移,溃疡封闭完全,主动脉壁间血肿均不同程度减轻或消失,恢复满意,症状消失.结论 TEVAR是一种比较安全有效的治疗PAU的方法,但其疗效仍缺乏充分的循证医学证据支持,仍需要进一步研究.Objective To investigate the early and mid -term results after thoracic endovascular aortic repair （TEVAR） of patients with penetrating atherosclerotic aortic ulcers （PAU）. Methods The clinical data and follow - up of 36 patients treated by TEVAR during 2009.5 - 2013.5 were retrospectively reviewed. Results Among the 36 patients [ 27 males and 9 females, median age （59.5 ± 8.7） years, range, 41 - 79 years ], 29 patients （ 80.6% ） showed chest and/or back pain. All patients were diagnosed of PAU by aortic enhanced computed tomography （CT） and stent grafts were implanted. The technical successful rate was 100%, 30 patients were observed in ICU, the in - hospital duration was 3 - 63 （ 16.43 ± 14.69） hours, the postoperation in - hospital duration was 4-14 （6.78 ± 2. 11 ） days. Cerebral infarction occurred in one patient six days after the operation. All patients were followed up, mean follow- up was 3 -52 （22.5 ± 15.5）months, two patients suffered cerebral infarction and lead to one death 33 months after the operation. Two patients presented little type II endoleak, and sealed spontaneously three months postoporation, others＇stent grafts were in normal status, the intramural haematma were absorbed or disappeared completely, the results were satisfying. Conclusions TEVAR is a relatively safe and effective way to treat PAU, but still needs more evidence and further research.

关 键 词：主动脉疾病 外科学 血管假体植入 支架 治疗结果 溃疡 外科学 

分 类 号：R654.4[医药卫生—外科学]