腔内治疗升主动脉夹层的实验研究  

An experimental study of endoluminal stent-graft repair in ascending aortic dissection.

作　　者：刘小平[1] 郭伟[1] 张国华[1] 梁发启[1] 李荣[1] 马冰[1] 白冬晓[1] 黄丽洁[1] 

机构地区：[1]中国人民解放军总医院普通外科,北京100853

出　　处：《中国实用外科杂志》2002年第3期145-147,I002,共4页Chinese Journal of Practical Surgery

基　　金：军队"九五"科研攻关基金资助项目 (基金编码97Z0 60 )

摘　　要：目的　研制适合升主动脉夹层的支架型血管 ,探讨支架型血管放置的合理途径和方法 ;观察支架型血管放置后模型动物的病理生理变化及评估临床腔内治疗升主动脉夹层的可行性。方法　以国产镍钛记忆合金和人造血管为材料制作支架型血管系统 ,以犬制作升主动脉夹层动物模型 ,通过输送器在透视下将支架型血管经主动脉弓的头臂分支动脉释放在模型犬升主动脉适当的位置内 ,使支架型血管覆盖犬升主动脉夹层模型的内膜撕裂处 ,使夹层内口封闭 ,再经髂股动脉在降主动脉起始段放置合适的裸支架一枚 ,用来纠正或预防夹层在远处的产生和蔓延。结果　 7例实验动物升主动脉夹层模型均相当于DeBakeyⅡ型 ;7例实验动物中有 5例经右锁骨下动脉 ,1例经头臂干动脉 (预先行右颈总动脉、主动脉弓人造血管临时性转流 ) ,1例经左锁骨下动脉途径送入输送系统 ;支架型血管均准确迅速地放置在升主动脉内 ,覆盖夹层内破口位置 ,即刻造影显示 ,无明确的主动脉瓣关闭不全影象 ;术后观察 7例实验动物 ,2例由于失血过多等原因术后未能复苏外 ,另 5例均于术后 2 4h内复苏 ,3天内恢复正常饮食 ,观察期间内 ,神态、视听反射正常 ,四肢动脉搏动正常。术后第一周内尸检观察 5只实验动物显示升主动脉内支架型血管完好 ,有Objective To create ascending aortic dissection(AAD), an experimental model for endoluminal therapy. To assess the feasibility of endoluminal stent-graft repair(ESGR) in AAD, and the clinical prospection.Methods Stent-graft was constructed from nitinol Z stent covered with a silk graft. AAD was created in seven dogs ,and ESGR for AAD has been performed on the 7 dogs under X-ray guidance. Results DeBakeyⅡ model was well created in the 7 dogs , and the ESGR for AAD has been successfully performed on all the 7 dogs. There were two early deaths due to bleeding after the performance , in the other five dogs ,no severe complications,such as rupture or aortic valvular insufficiency and paralysis,were observed.Conclusion These early experimental studies support the hypothesis that ESGR may be a safe and effective treatment for selected patients with AAD.

关 键 词：支架型血管 腔内治疗 升主动脉夹层 实验研究 

分 类 号：R543.1[医药卫生—心血管疾病]