胸主动脉夹层动脉瘤腔内隔绝术中内漏的处理对策  

Management of endoleaks in endovascular graft exclusion for thoracic aortic dissection

作　　者：赵珺[1] 景在平[1] 包俊敏[1] 赵志青[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843-845,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 :探讨胸主动脉夹层动脉瘤 (TAD)腔内隔绝术 (EVGE)中内漏的评估、处理和预防方法。 方法 :对 116例接受EVGE的 Stanford B型 TAD患者术中出现的内漏采用单纯球囊扩张、增加延伸移植物 (cuff)封堵和促凝的方法进行处理。结果 :术中出现各种即时内漏 17例 (14 .6 5 %,17/ 116 ) ,10例采用球囊扩张 ,8例有效 (内漏量减少 ) ,无治愈病例 ;10例采用cuff,均有效 ,治愈 7例 ;4例采用促凝处理 ,有效、治愈各 1例。术中处理后带漏 9例 (7.76 %,9/ 116 )。内漏组死亡 2例(10 .5 0 %) ,非内漏组死亡 2例 (2 %)。结论 :对于 TAD患者 ,单纯球囊扩张对 EVGE术中内漏尤其近端内漏的治疗效果并非最佳 。Objective:To study the optimal choice to evaluate, treat and prevent endoleaks in the procedure of endovascular graft exclusion (EVGE) for thoracic aortic dissection (TAD). Methods:The endoleak cases among 116 patients received EVGE were managed by ballooning, cuffing and coagulate promoting methods. Results:Endoleaks were detected in 17 cases immediately after the stent graft(SG) were deployed (14.65%). The effective ratio of simple ballooning was 8/10;while the curative ratio was zero. The effective ratio of additional cuffs was 10/10, and the curative ratio was 7/10. The coagulation control method only had a 1/4 effective and curative ratio. Conclusion:For TAD patients, the simple ballooning in the EVGE procedure is not the optimal management for the proximal endoleaks, cuffing is the effective treatment.

关 键 词：胸主动脉夹层动脉瘤 腔内隔绝术 内漏 

分 类 号：R543.16[医药卫生—心血管疾病]