主动脉夹层腔内修复术中内膜脱套的原因及诊疗分析  

Causes and treatment of intimo-intimal intussusception in endovascular repair of aortic dissecting aneurysms

作　　者：张韬[1] 张学民[1] 李伟[1] 贾鑫[2] 戴相晨 张小明[1] Zhang Tao;Zhang Xuemin;Li Wei;Jia Xin;Dai Xiangchen;Zhang Xiaoming(Department of Vascular Surgery,Peking University People's Hospital,Beijing 100044,China;Department of Vascular Surgery,Chinese PLA General Hospital,Beijing 100853,China;Department of Vascular Surgery, General Hospital of Tianjin Medical University,Tianjin 300050,China)

机构地区：[1]北京大学人民医院血管外科,100044 [2]解放军总医院血管外科,北京100853 [3]天津医科大学总医院血管外科,300050

出　　处：《中华全科医师杂志》2019年第2期170-174,共5页Chinese Journal of General Practitioners

摘　　要：目的 探讨主动脉夹层腔内修复术中内膜脱套的原因及相关经验。 方法 回顾性分析多中心2017年1月至2018年6月行主动脉腔内修复术术中或术后发生的主动脉内膜7例脱套的患者临床资料。男5例,女2例,年龄34~64岁,平均47.1岁,病程8 h^3个月,6例表现为急性胸痛,1例为腹痛。所有患者术前均行CT血管造影明确诊断。手术方法主要为TEVAR治疗(6例)和腔内开窗(1例),并跟踪术后情况。 结果 7例患者均顺利完成补救手术,无中转开放手术。其中Ⅰ型1例,Ⅱ型5例,Ⅲ型1例,4例在远端补放支架,1例在近端补放支架,1例于肠系膜上动脉补放一枚裸支架,1例合并腹主动脉开窗支架植入术,2例支架后因残余狭窄行球囊塑形。术后1例死于多器官衰竭,1例因继发肾衰竭持续院外透析,其余5例患者均康复出院,住院时间7~21 d,无截瘫、肠坏死、下肢缺血和动脉破裂等并发症。 结论 腔内治疗相关主动脉内膜脱套是一种罕见高危并发症,早期发现并根据分型再次腔内修复仍安全可靠。Objective Todiscuss the causes and treatment of intimo-intimal intussusception in endovascular repair of aortic dissecting aneurysms. Methods This retrospective study included 7 patients with intimo-intimal intussusception who underwent endovascular repair of aortic dissecting aneurysms from January 2017 to June 2018. There were 5 males and 2 females aged 34 to 64 years (mean 47.1 years), with a clinical course from 8 hours to 3 months. Six cases presented with acute chest pain and 1 had abdominal pain. Preoperative CTA was performed in all patients to confirm the diagnosis. Six patients received thoracic endovascular aortic repair (TEVAR) and 1 receivedfenestration. Results The endovascular repairs were successful without converting to open surgery in all patients. Pathological classifications were 1 type Ⅰ, 5 type Ⅱ and 1 type Ⅲ. Four patients received another aortic stent at distal segment to cover the intimo-intimal intussusception and 1 patient at proximal site. One patients received another bare stent in the superior mesenteric artery, and 1 case received abdominal aortic stent implantation. Balloon was used in 2 cases to dilate the stenosis of aortic stents. The death occurred in 1 case at 3 days after surgery for metadata object description schema, and 1 patient needed continuous renal dialysis after discharge. The postoperative conditions (from 7 to 21 days) of other patients were normal without paraplegia, bowel necrosis, lower limb ischemia or arterial rupture. Conclusions The results indicate that the intimo-intimal intussusception in endovascular aortic dissecting aneurysms repair is rare and it is a severe complication. Re-endovascular aortic repair is a safe and reliable surgical approachbased on the type in early phase.

关 键 词：主动脉夹层 腔内修复术 动脉内膜 套叠 

分 类 号：R654.3[医药卫生—外科学]