腔内修复术治疗复杂型Stanford B型急性主动脉夹层疗效分析  

Endovascular repair of complicated Stanford B acute aortic dissection

作　　者：何瑞霞[1,2] 王雅[1] 王效增[1] 周铁楠[1] 刘艳杰[1] 荆全民[1] 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016 [2]锦州医科大学,辽宁锦州121001

出　　处：《临床军医杂志》2017年第6期593-596,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨腔内修复术治疗复杂型Stanford B型急性主动脉夹层(AAD)的安全性及有效性。方法回顾性分析自2002年4月至2016年2月于沈阳军区总医院心血管内科行腔内修复术治疗的99例复杂型急性Stanford B型AAD患者的临床资料,并分析其围术期特点及近、远期疗效。结果 99例患者均经腔内修复术治疗,98例成功植入支架,共植入支架104枚,其中,94例患者植入单支架,5例患者植入双支架。合并冠心病26例(26.3%),其中,7例(7.1%)合并严重冠状动脉狭窄,行经皮冠状动脉介入治疗,共植入冠状动脉支架8枚。7例(7.1%)患者在院死亡。在院期间无截瘫、脑卒中等并发症发生。77例患者获得随访,中位随访时间24个月。随访期间,9例(11.7%)患者死亡,其中,4例(5.2%)患者死于主动脉源性。1例(1.3%)患者因再发夹层再次行腔内修复术治疗。结论复杂型Stanford B型AAD病情凶险,预后差,应积极控制血压,进行主动脉腔内修复术治疗有利于降低病死率,有利于改善近远期预后,安全可行。Objective To evaluate the security and effect of endovascular repair（EVAR） of complicated Stanford B acute aortic dis- section（AAD）. Methods A retrospective study was performed on 99 cases of AAD patients with complicated Stanford B who were admitted from April 2002 to February 2016. Patients were treated with EVAR,the clinical characteristics of patients were collected, the perioperative characteristics and effects of short-term and long-term were analyzed. Results All the 99 patients underwent EVAR treatment ,98 operations were successful, 104 stents were implanted, including 94 cases of single-side stand and 5 cases of double-sides stand. There were 26 cases （26. 3 % ） of combined coronary heart disease, including 7 cases （7.1% ） of combined severe coronary ste- nosis who underwent percutaneous coronary intervention（PCI） with 8 coronary stents,7 cases （7. 1% ） died in hospital. There was no complications such as paraplegia and stroke. The 77 patients were followed up, median follow-up time was 24 months. During the fol- low-up period,9 cases （ 11.7% ） died,including 4 cases （5.2%） of cardiac deaths and 1 patient （ 1.3% ） with recurrent dissection treated with EVAR. Conclusion Complicated Stanford B AAD is dangerous, prognosis is poor, the blood pressure should be positively controlled. Therefore, endovascular repair is beneficial to reduce the fatality rate, is helpful for improving the prognosis of short-term and long-term, and is safe and feasible.

关 键 词：复杂型急性主动脉夹层 腔内修复术 疗效 

分 类 号：R654.2[医药卫生—外科学]