血管腔内移植物治疗Stanford B型夹层的探讨  

The treatment by endovascular stent-graft for Stanford B dissection suited.

作　　者：郭伟[1] 盖鲁粤[2] 刘小平[1] 张国华[1] 梁法启[1] 王春喜[1] 李荣[1] 

机构地区：[1]中国人民解放军总医院普通外科,北京100853 [2]中国人民解放军总医院心内科,北京100853

出　　处：《中国实用外科杂志》2002年第3期151-153,共3页Chinese Journal of Practical Surgery

基　　金：军队"九五"攻关重点课题经费资助 (97Z0 0 0 )

摘　　要：目的　探讨微创血管腔内技术治疗StanfordB型夹层的可行性、安全性、有效性及存在的问题。方法　应用CTA ,MRA ,DSA等影像学手段对 14例入选对象进行术前评估 ,选择合理移植物通过微创血管腔内技术对病人第一裂口进行封堵 ,观察治疗后裂口、假腔血栓状况、移植物状况、脏器供血状况及相关并发症。结果　 14例病人腔内操作技术成功率 10 0 % ,无围手术期死亡、中转手术、截瘫、脏器及肢体缺血、移植物移位等并发症。早期内漏 3例。随诊 1个月至 3年 ,2例内漏自愈 ,1例内漏仍在随访中。 12例假腔内完全血栓形成 ,1例血栓部分形成 ,1例无血栓形成。无迟发性内漏、移植物移位及死亡等。结论　血管腔内移植物封堵第一裂口治疗Stan fordB型夹层是一种简单、安全、有效的方法 ,但对手术适应证的选择、潜在并发症。Objective To discuss the feasibility, safety and efficacy of transluminal Stent-graft treatment for Stanford B dissection in selective patients. Methods All of the patients accepted preoperative evaluation by CTA,MRA or DSA. We used the proper Talent stent-graft to close the first entry site of aortic dissection in 14 cases and investigated the entry site closure, clotting in the false lumen, stent-graft,end organs blood support and other complications. Results The success rate of the technique was 100%.There was no perioperative death, conversion, paraplegia, end organ or limb ischemia or stent-graft migration.The entry sites were successfully closed in 11 cases ; In the remaining 3 cases there were perigraft leakage into the false lumen. During 1month to 3 years follow-up,2 endoleaks had disappeared but one was still followed up.There were completely clot(n=12),local clot(n=1)and no clot(n=1) in false lumen. There was no secondary endoleak, migration or death. Conclusion In cases of Stanford B dissection, the stent-graft is a simple, safe and effective tool for closing the entry site,but the application, complication and long term result are still not clear.

关 键 词：血管腔内移植物 治疗 STANFORD B型夹层主动脉瘤 适应证 

分 类 号：R543.16[医药卫生—心血管疾病] R622.4[医药卫生—内科学]