腰大池引流治疗急性主动脉夹层腔内修复术后截瘫的疗效分析  

Analysis of the efficacy of lumbar cistern drainage in the treatment of paraplegia after endovascular repair of acute aortic dissection

作　　者：黄伊东 张志文[1] 李文睿 靳磊 冯海[1] 张军[2] Huang Yidong;Zhang Zhiwen;Li Wenrui;Jin Lei;Feng Hai;Zhang Jun(Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Sub-Center of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院血管外科,北京100050 [2]首都医科大学附属北京友谊医院普外分中心,国家消化系统疾病临床研究中心,北京100050

出　　处：《国际外科学杂志》2024年第7期466-470,共5页International Journal of Surgery

摘　　要：目的评估腰大池引流(LCD)治疗急性主动脉夹层腔内修复术后截瘫的疗效。方法采用回顾性描述性研究方法分析2015年5月—2022年5月首都医科大学附属北京友谊医院收治的4例主动脉夹层经胸主动脉覆膜支架腔内修复术(TEVAR)后出现截瘫患者的病例资料。其中男性3例,女性1例;年龄38~65岁,TEVAR术后截瘫患者均接受LCD治疗。采用门诊和电话的方式进行随访,随访期限为12个月,观察影像学指标及临床疗效。结果4例TEVAR后截瘫患者中2例出院前完全恢复,1例患者术后3个月时完全恢复,1例患者随访12个月时仍存在感觉减退,肌力4级。4例患者的主动脉CT重建检查均未发现内漏,远端夹层动脉瘤没有增大表现。结论LCD能够缓解或治愈主动脉夹层行TEVAR术后出现的截瘫。ObjectiveTo evaluate the efficacy of lumbar cisterna drainage(LCD)in treating paraplegia after thoracic endovascular aortic repair(TEVAR)for acute aortic dissection.MethodsA retrospective descriptive study was used to analyze 4 patients with aortic dissection who developed paraplegia after transthoracic aortic stent graft repair(TEVAR)admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from May 2015 to May 2022.There were 3 males and 1 females,aged between 38 and 65 years old.All patients with paraplegia after TEVAR were treated with LCD.Follow-up was carried out by outpatient and telephone for 12 months.The imaging indicators and clinical efficacy were observed.ResultsTwo patients were fully recovered before discharge,one patient was completely recovered by about 3 months after surgery,and one patient still had reduced sensation and grade 4 muscle strength at 12 months of follow-up.The CT angiography of all 4 patients did not show any evidence of endoleak,and there was no enlargement of the distal dissecting aneurysm.ConclusionLumbar cisterna drainage can alleviate or cure paraplegia caused by spinal cord ischemia after TEVAR for acute aortic dissection.

关 键 词：主动脉 截瘫 脊髓缺血 夹层 腰大池引流 

分 类 号：R654.3[医药卫生—外科学]