主动脉夹层腔内修复术178例术后早期疗效分析

The endovascular repair of aortic dissection: early clinical results of 178 cases

目的探讨主动脉夹层腔内修复术的安全性、可行性、有效性和问题。方法1998年6月至2004年12月,共对178例主动脉夹层患者行腔内修复术治疗。其中急性期76例,慢性期102例;StanfordA型19例,SatnfordB型159例。局部或全身麻醉,在X线透视条件下将支架型人工血管经股动脉放置在主动脉夹层第1裂口位置,实现腔内修复。修复后观察真假腔血液动力学变化、内脏及下肢动脉供血的改变。结果10例分别同期进行左颈总、左锁骨下动脉或肝总动脉和肠系膜上动脉的旁路术。36例支架型人工血管一期覆盖左锁骨下动脉而未做血管旁路手术,术后左肱动脉平均收缩压(61.6±23.7)mmHg(1mmHg=0.133kPa)。移植物位于第8胸椎椎体水平以上159例,以下19例。围手术期死亡率3.4%(6/178)。即刻内漏发生率12.9%(23/178)。无移植物错放、移位、瘤体破裂、中转手术和截瘫等并发症发生。平均手术时间1.5h(0.5～4.3h),平均出血量140ml(30～500ml),平均恢复活动时间1.8d(0.5～21.0d),平均恢复饮食时间1.5d(0.5～9.0d),平均住院时间5.3d(3～18d)。所有受破坏的分支血管修复后真腔供血均得到明显改善或无变化。随访1～76个月,术后1个月内漏发生率为6.4%(11/172)。结论腔内修复术治疗主动脉夹层具有安全、可行、有效的特点。中、远期疗效有待进一步观察。

Objective To discuss the safety, feasibility, efficacy and problems of endovascular repair for aortic dissection. Methods From Jun,1998 to Dec,2004,178 aortic dissections were treated by stent-grafts, including 76 acute cases and 102 chronic cases,19 cases with Stanford A and 159 cases with Stanford B. Under local or general anesthesia, every stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray fluoroscopic. The changes of hemodynamic in true and false lumen ,visceral and limbs blood supply were investigated after operation. Results 10 cases combined with left common carotid artery or left subclavian artery or hepatic artery and superior mesenteric artery bypass.36 left subclavian arteries were covered simultaneously without bypass and the average blood pressure of left brachial artery was (61.6±23.7)mm Hg.The stent-grafts were deployed above thoracic 8 in 159 cases and below thoracic 8 in 19 cases. This group included 3.4% 30-day death rate, 12.9% endoleak rate after deployment, and without misplace of stent grafts, migration, rupture, conversion to open surgery and paraplegia complication.The average operation time 1.5 h(0.5—4.3 h),blood loss 140 ml(30—500 ml),movement recover time 1.8 d(0.5—21.0 d),food recover time 1.5 d (0.5—9.0 d). The true lumen blood supply in most of damaged visceral arteries were improved. Follow up between 1 month to 76 months,the endoleak rate was 6.4% one month later. Conclusion The endovascular repair is a safe, efficacy and feasible method to aortic dissection. The long term results keep in follow up.