Stanford B型主动脉夹层腔内修复术后远端主动脉重构的临床观察  

The distal aortic remodeling of Stanford type B aortic dissection after thoracic endovascular aortic repair

作　　者：张婉[1] 庄舜玖[1] 史振宇[2] 符伟国[2] 

机构地区：[1]复旦大学附属华东医院血管外科,上海市200040 [2]复旦大学附属中山医院血管外科,上海市200032

出　　处：《老年医学与保健》2016年第4期227-230,共4页Geriatrics & Health Care

基　　金：上海市老年医学临床重点实验室(13DZ2260700);上海市重要薄弱学科建设项目(2015ZB0501)

摘　　要：目的总结Stanford B型主动脉夹层腔内修复术后远端主动脉重构的随访结果。方法回顾性分析97例经腔内修复术治疗的B型主动脉夹层患者的临床资料,主要包括患者的基础情况、腔内修复术过程和随访情况。记录并比较术前及术后CT血管造影测量的远端主动脉各节段直径,包括膈肌(diaphragm,DP)水平、肠系膜上动脉(superior mesenteric artery,SMA)水平、肾动脉(renal artery,RA)水平和腹主动脉分叉(aortic bifurcation,AB)水平。结果所有入组患者近端破口均位于降主动脉,夹层撕裂范围局限于降主动脉13例(13.4%),沿着主动脉长轴顺向撕裂至腹主动脉32例(33.0%)、撕裂至髂动脉52例(53.6%)。58例(60%)存在内脏动脉受累,但无内脏缺血现象。远端主动脉四节段直径分别为DP(31.9±4.6)mm,SMA(27.4±3.8)mm,RA(24.4±3.9)mm和AB(21.3±3.5)mm。TEVAR技术成功率100%,围手术期无并发症。早期随访共76例,61例(80.3%)患者支架段完全血栓形成,56例(78.9%)患者远端主动脉段存在开放假腔。主动脉各节段中DP直径降低至(30.0±6.4)mm,而RA及AB主动脉较术前轻度扩张。中期随访60例,46例(76.7%)患者支架段主动脉完全血栓化,28例(46.7%)远端主动脉仍有假腔开放,远端主动脉各节段直径较术前早期改变不明显。术后早期DP直径较术前DP直径差异有统计学意义(P=0.03)。结论 TEVAR术后远端主动脉重构不尽相同,膈肌段主动脉直径稍缩小,远端主动脉仍有扩张趋势。多数患者支架段假腔血栓形成,重构满意。Objective To observe the distal aortic remodeling of Stanford type B aortic dissection （TBAD） after thoracic endovascular aortic repair （TEVAR）. Methods A retrospective analysis was performed on 97 TBAD patients. The clinical data was collected in detail, including baseline information, endovascular procedure and follow-up results. We measured the diameter of the distal aorta around the diaphragm （DP）, superior mesenteric artery （SMA）, the lower renal artery （RA） and the aortic bifurcation （AB）. Results The primary tear was all located in the descending aorta. The dissection was constrained in the descending aorta in 13 patients （13.4%）, and propagated anterogradely into the abdominal aorta in 32 patients （33.0 %） and into the iliac arteries in 52 patients （53.6 %）. Fifty-eight patients （60.0 %） had compromised visceral arteries without organic ischemia. Diameter of the 4 segments of the distal aorta was （31.9±4.6） mm in the DP, （27.4 ± 3.8） mm in the SMA, （24.4 ± 3.9） mm in the RA and （21.3 ± 3.5） mm in the AB, respectively. Technical success was achieved in all patients and the perioperative period was uneventful. During the early-term follow-up period, 76 patients were followed up. The stented aorta was thrombosed in 71 patients （93.4%）. The false lumen of the distal aorta was still patent in 56 patients （78.9 %）. Diameter of DA slightly decreased to （30.0±6.4） mm. Diameters of RA and AB expanded a bit. During the mid-term follow up period, 60 patients were followed up. The stented aorta was thrombosed in 46 patients （76.7 %） and the distal aorta was still patent in 28 patients （46.7 %）. Diameter of the 4 segments remained almost unchanged. Finally, the change in the diameter of DP during the early-term follow-up phase was significant （P=0.03） as compared to that of pre-operation. Conclusion The distal aortic remodeling varies after TEVAR. The DP segment shrank a bit, while the distal aorta remained a tendency of dilatation. T

关 键 词：主动脉夹层 腔内修复 直径 

分 类 号：R654.3[医药卫生—外科学]