单纯超声心动图引导胸主动脉腔内隔绝术中的应用研究  

Application of full echocardiography in guiding thoracic endovascular graft exclusion

作　　者：高雷[1] 吴勤[1] 徐新华[1] 周新民[2] 唐浩[2] 杨一峰[2] 

机构地区：[1]中南大学湘雅二医院湖南省心血管病研究所心脏超声专科,湖南长沙410011 [2]中南大学湘雅二医院湖南省心血管病研究所心血管外科,湖南长沙410011

出　　处：《中国现代医学杂志》2015年第18期50-55,共6页China Journal of Modern Medicine

基　　金：湖南省科技厅(No:2012FJ6014)

摘　　要：目的探讨应用单纯超声心动图在引导胸主动脉腔内隔绝术中的应用,包括超声心动图在术前检测、筛选病例,术中监测、引导置入覆膜支架和术后随访中的应用价值。方法 14例胸主动脉病变需行腔内隔绝术患者,术前通过经TTE结合CTA诊断、筛选病例,术中应用超声心动图再次评估病变,并全程单纯由超声心动图-经胸超声心动图(TTE)和经食道超声心动图(TEE)引导覆膜支架正确放置;术后经TTE对单纯超声引导腔内隔绝术成功患者进行定期随访,评估手术效果。结果 14例病例中,12例在单纯超声引导下成功置入覆膜支架,成功率85.7%,共计置入支架12个,所有病例术中超声心动图均能准确分辨真、假腔,对覆膜支架定位准确,近端破口或内膜溃疡被有效封闭。术后定期随访,覆膜支架位置固定好,无内漏、截瘫等严重并发症。结论单纯超声引导胸主动脉腔内隔绝术为胸主动脉病变的治疗提供了一种全新的思路和方法。超声心动图(含TTE、TEE)在单纯超声引导胸主动脉腔内隔绝术中对术前筛选病例、术中覆膜支架置入过程监测引导、术后评估疗效发挥重要作用。【Objective】To elucidate the application value of full echocardiography guidance during the procedure of thoracic endovascular graft exclusion（TEVGE）, particularly focusing on the application of echocardiography to screening cases, guiding and monitoring the placement of coated stents and postoperative follow-ups as well.【Methods】There were 14 patients of descending thoracic aortic disease who needed thoracic endovascular graft exclusion. The patients were diagnosed by transthoracic echocardiography（TTE） and CT angiography（CTA） before operation. During operation, the thoracic aortic disease was reassured and the parameters were remeasured, meanwhile,the placement of the coated stents was guided by echocardiography which included TTE and transesophageal echocardiography（TEE）. Patients also received postoperative follow-ups at regular intervals by TTE. 【Results】Among the 14 patients, 12 patients successfully received TEVGE treatment guided by echocardiography, making a87.5% successful rate. In all the patients, echocardiography accurately distinguished the true lumen from the false lumen. All the stents were located well to cover the aortic tears and ulcers. Postoperative regular follow-up showed that the coated stents were fixed well without leakage, paraplegia or other serious complications. 【Conclusions】TEVGE guided by full echocardiography provides a new strategy and method for descending thoracic aortic disease.Echocardiography（including TTE and TEE） gives accurate and accountable results and play a vital role in helping to screen cases before operation, guiding and monitoring the placement of the coated stents during operation and evaluating therapeutic efficacy after operation.

关 键 词：超声心动图 腔内隔绝术 覆膜支架 胸主动脉 主动脉夹层 

分 类 号：R540.45[医药卫生—心血管疾病]