创伤性胸主动脉假性动脉瘤的腔内治疗经验  

Endovascular treatment of traumatic thoracic aortic pseudoaneurysm

作　　者：张雄 罗明尧 方坤 郭媛媛 薛云飞 赵嘉伟 舒畅 Zhang Xiong;Luo Mingyao;Fang Kun;Guo Yuanyuan;Xue Yunfei;Zhao Jiawei;Shu Chang(Department of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China;Department of Vascular Surgery,Fuwai Yunnan Cardiovascular Hospital,Kunming 650032,China;Department of Vascular Surgery,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中国医学科学院阜外医院血管外科,北京100037 [2]云南省阜外心血管病医院血管外科,昆明650032 [3]中南大学湘雅二医院血管外科,长沙410011

出　　处：《中华普通外科杂志》2021年第1期15-19,共5页Chinese Journal of General Surgery

基　　金：北京市科技计划(D171100002917004);中国医学科学院医学与健康科技创新工程(重大协同创新项目)基金资助项目(2016-12M-1-016);云南省阜外心血管病医院院级科研课题(2019YFKT-05)。

摘　　要：目的︰探讨腔内修复治疗创伤性胸主动脉假性动脉瘤的可行性及安全性。方法﹐回顾性分析2015年10月至2018年10月在中国医学科学院阜外医院诊断为创伤性胸主动脉假性动脉瘤且接受腔内修复治疗的7例患者的临床资料及随访结果。结果7例患者年龄(51.2±11.0)岁。所有患者均在全身麻醉下于杂交手术室完成主动脉腔内修复手术。2例患者行胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR),3例患者行TVEAR联合烟囱技术重建左锁骨下动脉,1例患者行TEVAR联合预开窗技术重建左锁骨下动脉,1例患者行TEVAR联合左颈总动脉-左锁骨下动脉搭桥术。手术时间(90.1±27.4)min,术后住院时间(8.9±3.7)d,术后中位随访时间42.4个月。术后1,6、12个月及以后每年均接受主动脉CTA复查,1例联合烟囱技术重建左锁骨下动脉患者术后发生内漏,术后6个月复查CT显示内漏消失。围手术期及随访期间无患者死亡,无术后截瘫及脑卒中发生,无主动脉再次干预,所有假性动脉瘤瘤腔均实现血栓化。结论TEVAR治疗创伤性胸主动脉假性动脉瘤创伤小,恢复快,安全可行,早中期疗效满意。Objective To investigate the feasibility and safety of endovascular repair for traumatic thoracic aortic pseudoaneurysm.Methods From Oct 2015 to Oct 2018,the clinical and followup data of 7 patients diagnosed as traumatic thoracic aortic pseudoaneurysm in Fuwai Hospital of Chinese Academy of Medical Sciences were analyzed retrospectively.Results The patients average age was(51.2±11.0)years old.All patients underwent surgery in the hybrid operating room under general anesthesia.Two did thoracic endovascular aortic repair(TEVAR),three did TEVAR combined with chimney technique to reconstruct the left subclavian artery,and 1 had TEVAR combined with fenestration to reconstruct the left subclavian artery.One did TEVAR with left common carotid artery and left subclavian artery bypass.The mean operative time was(90.1±27.4)min,the mean postoperative hospital stay was(8.9±3.7)d,and the mean postoperative follow-up time was 42.4 months.All the patients received CTA reexamination of the aorta after 1,6,12 months and yearly thereafter.Type I endoleak was found in one patient with chimney technique to reconstruct of left subclavian artery after operation.CT showed that the type I endoleak disappeared 6 months after operation.There was no death,paraplegia or stroke during the perioperative period and follow-up period,and there was no aortic related reintervention.Conclusion TEVAR is a safe and effective method for the treatment of traumatic pseudoaneurysm of thoracic aorta,and the early and mid term results were satisfactory.

关 键 词：动脉瘤 假性 创伤 主动脉 胸 腔内治疗 

分 类 号：R654.2[医药卫生—外科学]