StanfordB型主动脉夹层动脉瘤腔内隔绝术后截瘫的预防对策  

Prevention of paraplegia after endovascular exclusion for Stanford B thoracic aortic dissection aneurgsm

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

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

出　　处：《介入放射学杂志》2003年第4期254-256,共3页Journal of Interventional Radiology

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

摘　　要：目的　探讨StanfordB型胸主动脉夹层动脉瘤 (TAD)腔内隔绝术 (EVE)后截瘫或轻瘫的综合防治措施。方法　回顾在 1998年至 2 0 0 1年实施的 116例TADEVE。对于可能发生截瘫的高危患者 ,术后常规给予地塞米松。结果　包括接受脊髓动脉造影者在内 ,成功释放并固定移植物的 115例中 ,均无截瘫或轻瘫发生。结论　EVE虽避免了长时间主动脉阻断 ,但仍可因封闭肋间动脉造成脊髓的严重缺血 ,包括选择性脊髓动脉造影、糖皮质激素在内的综合性预防措施能减小发生截瘫 /轻瘫的危险 ,而选择适当长度的移植物是其关键。Objective To assess the prophylactic measures of paraplegia and paralysis after endovascular graft exclusion(EVE) for Stanford B thoracic aortic dissections(TAD). Methods The records of 116 consecutive patients undergoing endovascular TAD repair from 1998 to 2001 were retrospectively reviewed. Steroids were administrated postoperatively in high risk patients likely to be candidates for paraplegia or paralysis. Results No paraplegia or paralysis occurred postoperatively in all cases, including the patient undengone selective spinal artery angiography (SSAA). Conclusions Transluminal repair can avoid spinal cord ischemia due to aortic cross-clamping, there is still a risk of spinal cord injury caused by occlusion of intercostal arteries under the cover of endograft. A combination of the prophylactic measures, including SSAA and steroids, have been able to reduce the risk of paraplegia and paralysis. A graft-stent of appropriate length is the key point fo this procedure.

关 键 词：STANFORD B型 主动脉夹层动脉瘤 腔内隔绝术 截瘫 地塞米松 脊髓缺血 

分 类 号：R654.3[医药卫生—外科学]