胸主动脉夹层动脉瘤腔内隔绝术中椎动脉缺血的预防  

Prevention of vertebral artery ischemia in using the endovascular graft exclusion technique for the treatmant of thoracic aortic dissection

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

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

出　　处：《外科理论与实践》2004年第1期27-29,共3页Journal of Surgery Concepts & Practice

基　　金：军队杰出人才基金(98J005);上海市卫生系统百人计划基金(97BR047)

摘　　要：目的:探讨腔内隔绝术治疗StanfordB型胸主动脉夹层动脉瘤时椎动脉缺血的预防方法。方法:对136例接受腔内隔绝术治疗的StanfordB型胸主动脉夹层动脉瘤病人,尤其是左锁骨下动脉血流受干扰者的病史资料进行回顾性分析。结果:136例病人中135例手术成功,66例左锁骨下动状脉开口受到干扰,其中5例因左锁骨下动脉距夹层破口太近,而有意将其封堵。8例有椎动脉缺血症,仅1例为急性脑缺血表现。2例术后被迫行颈动脉鄄椎动脉旁路术以缓解椎动脉缺血情况。而术前接受预防性颈动脉鄄椎动脉旁路术的4例病人,完全遮蔽左锁骨下动脉后无不适症状。结论:完全遮蔽左锁骨下动脉可能会引起左侧椎动脉的急性缺血而致严重并发症。根据夹层破口与左锁骨下动脉开口间的距离,术前选择性实施左颈动脉鄄左椎动脉旁路术可预防椎动脉缺血的发生。Objective To discuss the method of prevention of vertebral artery ischemia while using the endovascular graft exclusion technique for the treatment of Stanford B thoracic aortic dissection. Methods The data of 136 patients with Stanford B thoracic aortic dissection were studied retrospectively; they were treated endoluminally with Talent stent-grafts,inculding the cases in which the left subclavian artery (LSA) was occluded by the placement of the stent-graft. Results Of the 136 cases, 135 patients received successfully the endovascular operation, with 66 patients whose ostium of the LSA were disturbed by the placement of the stent-graft, including 5 cases of occluding intentionally the LSA. Eight patients presenred symptoms related to vertebral artery ischemia, while immediate neurological manifestation occurred only in one case. In two patients, a second surgical intervention had to be performed due to vertebral artery ischemia. In 4 patients having received prophylactic external carotid to vertebral artery bypass, none presented any malaise symptoms. Conclusions Complete occlusion of the LSA could cause acute ischemia of the vertebral artery and lead to severe complications. Prophylactic revascularization of the vertebral artery before the placement of endovascular graft exclusion would be beneficial if the distance between the ostium of the left subclavian artery and the cleft of the dissection are close to each other.

关 键 词：胸主动脉夹层动脉瘤 腔内隔绝术 椎动脉缺血 手术治疗 预防 

分 类 号：R654.3[医药卫生—外科学] R543.16[医药卫生—临床医学]