胸主动脉夹层动脉瘤腔内隔绝术中移植物的选择  

How to choose appropriate stent-grafts in endovascular graft exclusion for thorocic aortic dissection

作　　者：赵珺[1] 景在平[1] 赵志青[1] 包俊敏[1] 冯翔[1] 陆清声[1] 冯睿[1] 黄晟[1] 洪毅[1] 

机构地区：[1]第二军医大学长海医院血管外科,全军血管外科研究所上海200433

出　　处：《第二军医大学学报》2002年第8期836-838,共3页Academic Journal of Second Military Medical University

基　　金：军队杰出人才基金资助项目 (98J0 0 5 ) ;上海市卫生系统百名跨世纪优秀学科带头人培养计划基金(97BR0 4 7) ;上海市科技发展基金攻关计划项目(0 0 4 4 190 2 9) ;长海医院学科攀登计划基金资助课题

摘　　要：目的 :为选择合适的用于胸主动脉夹层动脉瘤 (TAD)腔内隔绝术 (EVGE)的移植物 (SG)提供参考。 方法 :根据我院 116例手术经验、参考国外资料 ,对 TAD进行 EVGE术中应用不同 SG的结构特点以及术后内漏和其他并发症情况进行总结。 结果 :应用了 2类、3种 SG系统。其中近端内漏 12例 ,远端反流 5例 ,肋间动脉反流 1例 ,其他原因 1例。 6例出现背痛。中转手术 1例 ,术后 8d内死亡 4例 ,其中 2例存在内漏。 结论 :用于 TAD的 SG系统应具有一定的强度、良好的柔韧性及弹性 ;裂口距左锁骨下动脉开口较远时 ,适合直形 SG;裂口距左锁骨下动脉开口较近时 ,弯曲 SG更适合动脉解剖形态。裂口位于弓上或距离左锁骨下动脉开口 <1.5 cm时 ,更适用带分支的 SG。Objective:To provide reference for choosing the appropriate stent graft (SG) system in endovascular graft exclusion (EVGE) for thoracic aortic dissection (TAD). Methods:The cases of TAD managed with EVGE in our hospital were summarized. The different characters of the SG endoleaks, other complications, and the special SG mentioned in oversea documents were also analyzed. Results:Two styles(3 kinds) SG were used in our experience. Proximal endoleaks occurred in 12 cases, among which 4 tears located in the inner arc of the aortic arch descending aorta conjugating area. There were also 4 distal, one intercostal and one other reflux.Thoracic pain occurred in 6 patients. Conversion to conventional operation was performed on one patient. Four patients died in the peri operative period, among which 2 had leakages. Conclusion:Desired characteristics of the SG should have appropriate strength, good flexibility and elasticity. When the tear locates at far distal of the left subclavian artery, tubular SG is suitable. When it locates near the left subclavian artery, curved SG is the better choice, while on the aortic arch or the distance short than 1.5 cm, branched SG may be more suitable.

关 键 词：胸主动脉夹层动脉瘤 腔内隔绝术 移植物 选择 

分 类 号：R543.16[医药卫生—心血管疾病]