胸主动脉夹层动脉瘤腔内隔绝术手术入路的探讨  

Surgical approach of endovascular exclusion for thoracic aortic dissection.

作　　者：叶波[1] 景在平[2] 冯翔[2] 

机构地区：[1]江西省赣州市人民医院普外科,341000 [2]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

出　　处：《介入放射学杂志》2003年第4期270-272,共3页Journal of Interventional Radiology

摘　　要：目的　探讨为胸主动脉夹层动脉瘤 (TAD)行腔内隔绝术 (EVE)选择合适的导入动脉。方法　以彩超 ,CTA或MRA为检查手段 ,评估导入动脉 (股动脉、髂总动脉、腹主动脉下段等 )的直径大小(≥ 8mm)、有否硬化斑块、狭窄、是否被夹层累及、有否扭曲及其程度 ,从而选择具体的手术入路。结果　本组 37例TAD行EVE术所选择经股动脉手术入路 2 3例、经髂总动脉手术入路 14例。未选择经腹主动脉下段手术入路。即时操作成功率为 10 0 %。结论　合理的选择导入动脉作为手术入路 ,是EVE手术治疗TAD顺利完成的要点。Objective To evaluate the surgical approach of endovascuar exclusion for thoracic dissection.Methods Thirty-seven cases of Stanford B type thoracic aortic dissection were undergone endovascular exclusion (EVE) and had been studied retrospectively. Preoperative evaluations for delivery arteries, including common femoral artery, iliac artery, and abdominal aorta, were earried out by using duplex ultrasonography (US), computed tomographic angiography (CTA) and magnetic resonance angiography(MRA). Factors such as arterial calibers, stenosis, tortuosity, sclerotic plaque and media dissection were taken into account. Choices of surgical approach were decided after comprehensive consideration of these factors. If the common femoral artery inner diameter was wider than 8 mm, without severe iliac artery stenosis or tortuosity; the common femoral artery should be selected as the delivery artery. In case of severe arterial stenosis and tortuosities, then the common iliac arteries were exposed by retroperitonial approach and graft was delivered through this artery. Results Mural sclerotic plaques were more sensitive to be revealed by US, conversely with CTA and MRA in showing stenosis and tortuosity directly and clearly. Utilizing this preoperative evaluating system, all the grafts passed successfully and favourably through the arteries, without any delivery artery associated complications.Conclusions Using US, CTA and MRA in combination was necessary for preoperative evaluation of the delivery artery. In those with poor femoral artery condition, exposing common iliac artery decidedly is necessary to ensure the procedure favorably and to avoid delivery artery associated complications.

关 键 词：胸主动脉夹层动脉瘤 腔内隔绝术 手术入路 微创技术 影像学检查 

分 类 号：R654.3[医药卫生—外科学]