150例Stanford B型主动脉夹层动脉瘤腔内手术回顾

Review of 150 cases of Stanford type B aortic dissecting aneurysms treated by endovascular placement of stent-grafts

目的:总结150例StanfordB型主动脉夹层动脉瘤的腔内手术治疗经验。方法:术前对病人进行多种影像学检查,以获得主动脉夹层动脉瘤的有关解剖学资料。术中在DSA监视下对150例StanfordB型主动脉夹层动脉瘤施行了人工血管内支架安置术。术后1周和术后1年,作螺旋CT以观察手术疗效及有无内漏、移位和人工血管内支架塌陷等术后并发症。结果:148例(98.6%)获临床成功。围手术期内,1例(0.67%)死亡,1例(0.67%)发生脑梗死。术后截瘫发生率为零。26例(17.3%)发生内漏。结论:与传统手术相比,腔内治疗StanfordB型主动脉夹层动脉瘤具有创伤小、严重并发症少、住院时间较短的优势。近期和中期疗效令人满意,但远期疗效还有待于更长的随访。

Objective To introduce the experience of treating 150 cases of Stanford type B aortic dissecting aneuryms by endovascular implantation of stent-grafts. Methods Imaging examination by various technigues were done to obtain anatomical detaile of the aneurysm. Stent-grafts were implanted under the guidance of DSA in 150 cases of Stanford type B aortic dissecting aneurysms. Follow-up study by spiral CT was performed 1 week and 1 year postoperatively to observe the efficacy of the procedure and the complications of stent implantation such as endoleak, migration and fracture of stent-graft. Results One hundred and forty-eight cases(98.6%) were treated successfully, while 1 case(0.67%) died and 1 case (0.67%) was complicated by cerebral infarction during the perioperative period; no postoperative paraplegia has occurred; endoleak occurred in 26 cases(17.3%). Conclusions Endovascular therapy of the Stanford type B aortic dissecting aneurysms possesses the advantages of being micro-invasive, producing less severe complications, demanding shorter hospital stay in contrast to the traditional operation. The short-term and mid-term efficacy are satisfactory, however, further follow-up is required to confirm the long-term efficacy.