腔内隔绝术治疗Stanford B型主动脉夹层——116例临床分析  

Endovascular stent-grafts exclusion for Stanford B type aortic dissections: 116 cases report

作　　者：景在平[1] 冯翔[1] 包俊敏[1] 赵志青[1] 赵珺[1] 陆清声[1] 叶必远[1] 

机构地区：[1]第二军医大学附属长海医院血管外科暨全军血管外科研究所,上海200433

出　　处：《中国胸心血管外科临床杂志》2003年第1期14-17,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：军队杰出人才基金 (98J0 0 5 ) ;上海市卫生系统百人计划基金 (97BR0 47) ;上海长海医院学科攀登计划基金资助项目

摘　　要：目的　探讨腔内隔绝术 (EVGE)治疗 Stanford B型主动脉夹层动脉瘤的手术指征、术前评估方法、手术操作技巧、并发症防治原则及临床应用前景。　方法　对自 1998年 9月至 2 0 0 1年 12月间施行的 116例 Stanford B型胸主动脉夹层动脉瘤 EVGE进行了回顾性研究。术前 CT血管造影 (CTA)或磁共振血管造影 (MRA)显示 :夹层动脉瘤最大直径平均 6 6 .2± 18.1mm,72例患者表现为单一夹层裂口 ,4 4例表现为多裂口。经股动脉或髂动脉将移植物导入胸主动脉封闭夹层裂口 ,手术在数字剪影血管造影 (DSA)监视下完成。　结果　术中移植物成功释放 115例 ,72例单一夹层裂口患者中 6 2例使用单一移植物 ,8例使用 2个移植物 ,2例使用 3个移植物 ,6例手术结束时残存 I型内漏 ;4 4例多夹层裂口者 ,18例使用 2个移植物同时封闭不同部位夹层裂口 ,2 6例远端夹层裂口旷置 ,1例中转开胸手术。平均随访时间 15 .4± 11.2个月 ,围手术期死亡 6例 ,其余病例术后无心、肺、肾功能衰竭及截瘫等严重并发症 ;术后 11个月猝死 1例 ,2例分别于术后 14个月和 2 4个月再发 Stanford A型胸主动脉夹层而行 Bentall手术 ,其余患者未出现与夹层及手术相关的并发症。　结论　 EVGE治疗 Stanford B型主动脉夹层动脉瘤是一种创伤小。Objective To assess the operative indications, preoperative evaluation, technique essentials and clinical prospection of endovascular graft exclusion(EVGE) for thoracic aortic dissection. Methods Since September 1998 to December 2001, EVGE for thoracic aortic dissection had been performed in 116 patients. Preoperative computed tomography angiography(CTA) or magnetic resonance angiography(MRA) showed the average diameter of the aneurysm was 66.2±18.1mm, seventy two patients had one tear and 44 patients had more than one tear. Graft was constructed from self expanding Z stents covered with a woven Dacron polyester fabric graft. Graft dimensions were determined from spiral computed tomographic scans. All operations were performed under digital subtraction angiography (DSA) guidance. Results The grafts were installed successfully in 115 patients. In 72 patients with one dissection tear, 62 used one stent graft, 8 used 2 stent grafts and 2 used 3 stent grafts, 6 patients had endoleaks till the operation completed. In 44 patients who had more than one dissection tears, 18 used two stent grafts for different tear, 26 patients had the proximal tear been excluded. The mean follow up time was 15.4±11.2 months, 6 patients died within the peri operative period, 2 patients died during the follow up, 2 patients had recurrence of thoracic dissection(Stanford A) and cured by Bentall operation. The others were in good state, no accidents related to the dissection and operation were observed. In 67 patients followed up for more than 12 months, thrombosis in false lumen was achieved in all patients, the aneurysmal diameter decreased obviously, the position and shape of the graft was good. Conclusions EVGE may be a safe and effective treatment for selected patients with thoracic aortic dissection. Endoleak may lead to aneurysmal expansion and rupture. Further follow up is necessary to evaluate its long term effectiveness.

关 键 词：腔内隔绝术 治疗 STANFORD B型 主动脉夹层 临床分析 

分 类 号：R654.3[医药卫生—外科学]