主动脉分区在主动脉夹层腔内治疗方式选择中的意义  

Significance of thoracic aortic partition in endovascular repair of thoracic aortic dissection

作　　者：丁盛[1] 张近宝[1] 张立平[1] 欧阳辉[1] 高峰[1] 邬晓臣[1] 

机构地区：[1]成都军区总医院心血管外科中心,成都610083

出　　处：《第三军医大学学报》2015年第20期2086-2090,共5页Journal of Third Military Medical University

摘　　要：目的探讨主动脉分区在不同类型主动脉夹层腔内治疗方式选择中的意义。方法 2009年1月至2015年1月成都军区总医院心血管外科共对208例诊断为主动脉夹层的患者完成了经股动脉腔内支架植入术,其中42例夹层破口位于主动脉弓或升主动脉的患者先建立了头臂动脉间或升主动脉至头臂动脉的血管旁路,然后再完成腔内支架植入(杂交技术)。按照头臂血管分支与主动脉之间的关系将胸主动脉依次分为-1、0、1、2、3、4区共6个区域。根据夹层破口所在的区域不同,采用个体化的腔内治疗方式,对破口位于升主动脉或降主动脉(-1区、3区、4区)且不累及重要主动脉分支的夹层患者采用单纯腔内支架隔绝术,对累及重要头臂分支的夹层患者,先建立头臂动脉之间的血管旁路或升主动脉与头臂动脉间的旁路,再进行腔内支架隔绝术。结果无围术期死亡及严重并发症的发生,术后复查支架及旁路血管内血流通畅。1例患者出现Ⅰ型内漏,1例患者出现Ⅱ型内漏,1例患者术后1个月时支架远端主动脉内膜再次发生破裂,重新植入1枚支架后痊愈。其余患者术后3个月至1年复查时情况良好,无明显的胸痛、气紧等症状,支架及旁路内血流通畅,无支架移位及内漏发生。所有患者于术后3个月及术后1年常规复查,此后每年随访1次,20例患者术后1年失访。结论按主动脉分区对不同类型主动脉夹层的腔内治疗进行个体化方案选择,有利于简化手术方式,拓宽血管腔内治疗的适应证。Objective To investigate the significance of aortic partition in endovascular repair of different types of thoracic aortic dissection. Methods From January 2009 to January 2015, a total of 208 patients successfully completed stent graft implantation via femoral artery, and bypasses were established between the ascending aorta and brachiocephalic artery or between the brachiocephalic arteries in 42 patients receiving hybrid procedure. According to the relationship between the aorta and brachiocephalic artery, the thoracic aorta was divided into 6 zones ： zone - 1, zone 0, zone 1, zone 2, zone 3 and zone 4. According to the position of dissection, individualized endovascular repair was employed. If the aortic dissection was located in the ascending aorta or descending aorta and the important branches were not involved （ zone - 1, zone 3, and zone 4）, single endovascular repair was adopted. If the important branches of the aorta were involved, the bypasses were established between the ascending aorta and brachiocephalic artery or between the brachiocephalic arteries, and then endovascular repair was performed. Results No death and severe complications occurred in the perioperative period. Blood flows in the stent grafts and bypass grafts were smooth. Endoleakage appeared in 2 patients who received hybrid procedure. The aortic intima of 1 patient was ruptured again at the distal stent graft in 1 month post-operatively, and true lumen was severely compressed. But the patient was recovered after another stent graft was implanted. The other patients showed good conditions without obvious symptoms. All patients were followed up in 3 months and 1 year after operation. The follow-up of 20 patients was lost after postoperative 1 year. Conclusion Individualized plan is selected according to the aortic partition of different types of aortic dissection, which is conducive to simplifying operation method and widening the application of endovaseular repair in aortic dissection.

关 键 词：胸主动脉分区 主动脉夹层 腔内治疗 杂交技术 

分 类 号：R322.121[医药卫生—人体解剖和组织胚胎学] R540.46[医药卫生—基础医学]