Stanford B型主动脉夹层远端破口的腔内治疗策略  

Endovascular treatment strategies for distal entry tear of Stanford type B aortic dissection

作　　者：徐乐吟 来志超[1] 邵江[1] 李康[1] 张新[1] 马江宇 刘暴[1] Xu Leyin;Lai Zhichao;Shao Jiang;Li Kang;Zhang Xin;Ma Jiangyu;Liu Bao(Department of Vascular Surgery,Peking Union Medical College Hospital,Chinese Academy Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院血管外科,100730

出　　处：《中华外科杂志》2021年第8期711-715,共5页Chinese Journal of Surgery

基　　金：北京市自然科学基金(7182131);中国医学科学院医学与健康科技创新工程(2018-I2M-AI-004);中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2019XK320004)。

摘　　要：目前,胸主动脉腔内修复术是复杂型Stanford B型主动脉夹层的首选治疗方法。但该手术并未封闭夹层远端破口,假腔血流可持续存在,导致主动脉无法重塑甚至发生夹层进展。尤其是慢性Stanford B型主动脉夹层患者,内膜瓣已发生增厚和纤维化,主动脉重塑更加困难。研究结果显示,远端破口的存在可增加患者发生远期主动脉事件的可能性。对于部分高危患者,进行传统胸主动脉腔内修复术的同时,有必要对远端破口进行处理。现有的远端破口腔内治疗方法包括PETTICOAT、STABILISE、覆膜支架、开窗或分支支架、假腔栓塞、封堵器、Knickerbocker等。但多数方法报道的病例数极为有限,其适用范围及疗效仍处于探索阶段,临床医师应根据实际情况,精细化制定治疗方案。Currently,thoracic endovascular aortic repair(TEVAR)is the first-line treatment for patients with complicated Stanford type B aortic dissections.However,TEVAR does not occlude the distal entry tear of dissections,and blood flow persists in the false lumen.Dissections might progress in some patients.Studies showed that distal entry tear increased the possibility of late aortic events during follow-up.Thus,treatment of distal entry tear is necessary in some high-risk patients after TEVAR.In this article,the current treatment strategies of distal entry tear are summarized,which include PETTICOAT,STABILISE,covered stent,fenestrated and branched stent-grafts,false lumen embolization,vascular occluder,and Knickerbocker.However,the number of the cases of most approaches is so limited that the indications and effectiveness need to be further studied.Selecting the right treatment for the right patient is of great importance.

关 键 词：动脉瘤 夹层 血管内手术 主动脉 远端破口 

分 类 号：R654.3[医药卫生—外科学]