摘要
目的探讨胸主动脉腔内修复术(TEVAR)治疗Stanford B型主动脉夹层(AD)方法与疗效。方法回顾性分析2010年1月至2016年4月采用TEVAR治疗的85例Stanford B型AD患者临床资料。85例患者均常规行左肱动脉穿刺,右侧股动脉直切口,升主动脉DSA造影明确AD破口位置、真假腔及与重要器官血管开口位置关系;置入覆膜血管内支架,封堵原发破口,升主动脉造影复查观察近端破口封闭情况及主动脉弓部分支血管、真假腔血流变化情况。结果 84例患者TEVAR手术成功,成功率100%;1例术前麻醉过程中突发AD破裂死亡。9例部分覆盖左锁骨下动脉,1例左锁骨下动脉"烟囱"支架完全封闭左颈总动脉和左锁骨下动脉,2例行无名动脉至左颈总动脉和左锁骨下动脉转流。Ⅰ型内漏2例,无住院期间死亡。术后随访3个月至3年,患者均存活,远端再发新破口2例。结论 TEVAR术治疗Stanford B型AD安全有效,严格把握手术指征、术中精细操作及加强术后院外管理是手术成功、提高远期生存率关键。
Objective To explore the technology and curative effect of thoracic endovascular aortic repair （TEVAR） for Stanford type B aortic dissection. Methods The clinical data of 85 patients with Stanford type B aortic dissection, who were admitted to authors＇ hospital during the period from January 2010 to April 2016 to receive TEVAR, were retrospectively analyzed. Conventional left brachial artery puncture and straight incision of right femoral artery were employed in all 85 patients, and DSA of ascending aorta was performed to find out the position of rupture, the position of the true and false lumens, and their relationship with the vascular openings of important organs. Endovascular covered stent was implanted to seal off the primary rupture; reexamination of ascending aorta angiography was adopted to check the sealing-off condition of the proximal rupture and the changes of blood flow in the aortic branches as well as in the true and false lumens. Results Successful TEVAR was accomplished in 84 patients. One patient died of sudden rupture of aortic dissection during preoperative anaesthesia. The technical success rate was 100%. In 9 patients the covered stent partially overlapped the left subclavian artery, in one patient the left subclavian artery ＂chimney＂ stent completely obstructed both the left common carotid artery and the left subclavian artery, and bypass surgery between left common carotid artery and left subclavian artery was carried out in 2 patients. After the treatment, internal leakage of type I was detected in 2 patients. No death occurred during hospitalization period. After the surgery the patients were followed up for 3 months to 3 years, and all patients survived. New rupture at the distal site occurred in 2 patients. Conclusion For the treatment of Stanford type B aortic dissection, TEVAR is safe and effective. Strict observance of surgical indications, careful operative manipulation, and strengthening postoperative management after discharge from hospital are the key points to ensure a successful surgery as well as to improve the long-term survival rate.
作者
王喜明
张艳霞
余海彬
李明
王宏山
赵根尚
法宪恩
WANG Ximing ZHANG Yanxia YU Haibin LI Ming WANG Hongshan ZHAO Genshang FA Xianen.(Department of Cardiovascular Surgery, Second Affiliated Haspital of Zhengzhou University, Zhengzhou, Henan Province 450014, China)
出处
《介入放射学杂志》
CSCD
北大核心
2017年第7期651-654,共4页
Journal of Interventional Radiology
基金
河南省卫生科技创新型人才工程项目(201004120)
