覆膜支架治疗胸降主动脉夹层

Stent-graft on aortic dissections

目的 探讨覆膜支架治疗胸降主动脉夹层的方法和疗效。方法 对 11例胸降主动脉夹层患者行覆膜支架治疗。术前强化 CT检查明确诊断 ,根据病变血管近侧正常血管直径加上其直径的 15 %～ 2 0 %选择支架型号。术中先行主动脉造影 ,确定内膜破口位置 ,分辨真假腔 ,选择恰当的手术入路及合适的支架。腹股沟处切开 ,游离出股动脉并切开 ,插入支架输送器 ,降血压 ,于破口位置缓慢释放覆膜支架 ,封闭主动脉内膜破口。重新造影 ,观察支架的位置 ,检查是否有内漏。结果 11例均成功植入支架 ,患者疼痛症状消失 ,升主动脉造影示真腔扩大 ,9例假腔血流消失 ,2例有内漏。所有病例随访 3～ 30个月 ,无死亡。术后 1、3、6个月和满 1年分别行强化 CT检查。2例内漏患者中 ,1例 3个月后自行封闭 ,1例因破口大 ,靠近左锁骨下动脉口 ,术后 3个月仍有内漏。2例肾动脉受影响者血流明显改善。 5例胸膜后血肿患者术后 3个月完全吸收。无截瘫、左上肢缺血等并发症。结论 覆膜支架治疗胸降主动脉夹层创伤小 ,操作简单 ,手术死亡率低 ,并发症少 。

Objective To study the treatment method and results of polyester-covered stent-grafts on type B aortic dissection.Methods 11 patients with type B aortic dissection were treated by polyester-covered stent-grafts.The size and length of the required prosthesis were selected according to aortography during the procedure.After aortography the deployment site was marked where the aortic intima teared.The stent-graft was introduced through the femoral artery in the angiography suite,under general anesthesia with systemic heparinization and induced hypotension.Results The procedure was successful in all 11 patients.There was no hospital mortality.Residual blood flow in the false lumen persisted in 2 patients,due to leakage at the proximal end of the stent-graft.During follow-up of 3 to 30 months,no paraplegia,no arm weakness and late death occurred.Conclusions Stent-grafts is an important mean on type B aortic dissections,with less invasive,low complication rate and mortality,and less hospital stay.