高龄急性胸主动脉综合征患者的腔内修复治疗  

Endovascular repair in elderly patients with acute thoracic aortic syndrome

作　　者：王锋[1] 刘宝辉[1] 吴恩刚 刘典晓[1] 李伟[1] 王玉玖[1] 董圣军[1] WANG Feng;LIU Baohui;WU Engang;LIU Dianxiao;LI Wei;WANG Yujiu;DONG Shengjun(Department of Cardiovascular Surgery,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China)

机构地区：[1]滨州医学院附属医院心脏大血管外科,山东滨州256603

出　　处：《滨州医学院学报》2023年第4期288-291,共4页Journal of Binzhou Medical University

摘　　要：目的探讨主动脉腔内修复术在高龄急性胸主动脉综合征(AAS))患者中的治疗效果。方法回顾性分析采用主动脉腔内修复术治疗的80岁以上高龄AAS患者的临床资料,分析这些患者围手术期主要并发症的情况,并对其进行随访,观察其主动脉假腔直径及血肿厚度的变化情况。结果20例患者均获得手术成功,其中8例采用“体外预开窗”技术行主动脉腔内修复手术。围手术期并发症情况:内漏者1例,中枢神经系统损伤者2例;穿刺部位出血者1例。术后6个月复查主动脉CT血管造影(CTA)显示:8例主动脉夹层患者,人工血管覆盖区假腔完全闭合,真腔直径明显增加,人工血管非覆盖区,真腔及假腔直径均无明显变化;12例主动脉壁内血肿及/或穿透性主动脉溃疡患者,人工血管覆盖区溃疡病灶完全血栓化,血肿厚度减少(P<0.05),人工血管非覆盖区,血肿厚度无明显变化。结论主动脉腔内修复术,特别是联合左侧锁骨下动脉“体外预开窗”技术,在治疗高龄AAS患者中具有良好的临床效果。Objective To investigate the therapeutic effect of endovascular aortic repair in elderly patients with acute aortic syndrome.Methods The clinical data of 20 patients over 80 years old with acute thoracic aortic syndrome who received endoaortic repair were retrospectively analyzed.The main complications in perioperative period of these patients were analyzed and they were followed up to observe the changes of aortic pseudolumen diameter and hematoma thickness.Results All the 20 patients were successfully operated,and 8 of them were treated with"extracorporeal prefenestration"technique.Perioperative complications were internal leakage in 1 case,central nervous system injury in 2 cases,and puncture sitebleedin 1 case.Six months after the operation,CTA of the aorta showed that the pseudolumen of the aorta in the artificial vessel coverage area of 8 patients with aortic dissection was completely closed,and the diameter of the pseudolumen was significantly reduced(P<0.01);the diameter of aortic pseudolumen did not change significantly in the non-covered area.In 12 patients with aortic intramural hematoma and/or penetrating ulcer,the thickness of hematoma in the artificial vessel coverage area decreased 6 months after the operation(P<0.05);In the non-covered area,there was no significant change in hematoma thickness.Conclusion Endovascular aortic repair,especially the application of extracorporeal prefenestration,has a good clinical effect in the treatment of elderly patients with acute thoracic aortic syndrome.

关 键 词：主动脉腔内修复术 急性主动脉综合征 高龄 

分 类 号：R543.1[医药卫生—心血管疾病]