“烟囱”支架在急性期锚定区不足的Stanford B型主动脉夹层中的应用体会  

Chimney stent in acute Stanford type B aortic dissection with insufficient anchorage zone

作　　者：陈松伟[1] 林少芒[1] 张智辉[1] 萧剑彬[1] 李强[1] 艾文佳[1] 李阳勇[1] Chen Songwei;Lin Shaomang;Zhang Zhihui;Xiao Jianbin;Li Qiang;Ai Wenjia;Li Yangyong(Department of Vascular Surgery,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广州医科大学附属第二医院血管外科,广州510260

出　　处：《中华普通外科杂志》2022年第2期113-117,共5页Chinese Journal of General Surgery

基　　金：广东省科技计划项目(2020A1414040039);广东省医学科学技术研究基金项目(A2020317)。

摘　　要：目的探讨应用胸主动脉腔内修复术(thoracic endovascular aotic repair,TEVAR)治疗急性期锚定区不足假腔未血栓化的Stanford B型主动脉夹层时"烟囱"支架重建左锁骨下动脉(left subclavian artery,LSA)的治疗效果。方法回顾性分析2013年2月至2021年1月采用TEVAR结合"烟囱"支架重建LSA治疗急性期锚定区不足假腔未血栓化的39例Stanford B型主动脉夹层患者的治疗效果。结果39例Stanford B型主动脉夹层应用覆膜"烟囱"支架11例,裸"烟囱"支架28例,均成功植入主体支架及"烟囱"支架,术后无脑卒中、左上肢缺血、截瘫、偏瘫及死亡病例,无支架移位、逆撕、夹层破裂等表现;1例裸"烟囱"支架术后18个月出现堵塞,余"烟囱"支架随访均通畅。覆膜"烟囱"支架组和裸"烟囱"支架组的即时Ⅰa型内漏发生率分别为0(0/11)和32.1%(9/28)(P=0.04);覆膜"烟囱"支架组、裸"烟囱"支架未内漏亚组与内漏亚组的近端破口和LSA间距离分别为(5.1±2.3)、(14.4±5.2)和(7.8±7.0)mm(P<0.05)。术后2~8周内漏亚组假腔血栓化,内漏消失。结论在TEVAR结合"烟囱"支架治疗急性期锚定区不足假腔未血栓化的Stanford B型主动脉夹层时,裸"烟囱"支架重建LSA发生即时Ⅰa型内漏与近端破口和LSA的距离具有相关性,而覆膜烟囱支架可减少即时Ⅰa型内漏发生率。Objective To investigate the effect of chimney stent for reconstruction of left subclavical artery(LSA)in thoracic endovascular aotic repair(TEVAR)for acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen.Methods TEVAR with chimney stent for LSA in 39 cases of acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen was done from Feb 2013 to Jan 2021.Results Covered chimney stents was used in 11 cases and bare chimney stents in 28 cases.There was no postoperative stroke,left upper limb ischemia,paraplegia,hemiplegia and death.No stent migration,reverse tear and dissection rupture were observed.One bare stent was obstructed after 18 months,and all the remaining stents were patent during follow-up.The rate of immediate typeⅠa endoleak in covered chimney stent group and bare chimney stent group were 0(0/11)and 32.1%(9/28)respectively(P=0.04).The distance from proximal tear to LSA in covered chimney stent group,endoleak subgroup and non-endoleak subgroup in bare chimney stent were(5.1±2.3)mm,(14.4±5.2)mm and(7.8±7.0)mm respectively(P<0.05).False lumen thrombosis was formed in endoleak subgroup 2-8 weeks after operation,and endoleak disappeared.Conclusions There is a correlation between immediate typeⅠa endoleak in bare chimney stent for LSA and the distance from proximal tear to LSA,covered chimney stent can reduce the incidence of immediate typeⅠa endoleak in TEVAR for acute Stanford type B aortic dissection with insufficient anchorage zone and non-thrombotic false lumen.

关 键 词：主动脉疾病 血管外科手术 内漏 烟囱技术 

分 类 号：R654.3[医药卫生—外科学]