覆膜支架治疗Ⅲ型主动脉夹层

目的探讨覆膜支架治疗Ⅲ型主动脉夹层的方法和疗效。方法对14例Ⅲ型主动脉患者行爱膜支架治疗。术前强化CT检查明确诊断。术中先行主动脉造影，明确内膜破口位置，分辨真假腔，然后根据病变血管近端正常血管直径加上其直径的15％～20％选择支架型号。沿腹股沟下方约2cm处横行切开，游离股动脉并切开，插入支架输送器，硝普钠降收缩压至70～90mmHg，于破口位置缓慢释放支架，封闭主动脉内膜破口，重新造影，观察支架位置，是否有内漏．．结果14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，假腔消失12例，小内漏2例（经球囊扩张后仍有）。术后1周，1、6个月行强化CT检查示真腔扩大，假腔内血栓形成并缩小，远断血运改善，无截瘫、左上肢缺血及支架移位等并发症．结论覆膜支架治疗Ⅲ型主动夹脉层创伤小，操做简单，手术死亡率低，并发症少．恢复快，近期效果好．

Objective To study the treatment method and results of polyester- coverd stent - grafts on type Ⅲ dissection, Methods 14 patients with type Ⅲ. Methods aortic dissection were treated by polyester - coverd stent - grafts, The size and length of the reqired prosthesis were selected according to aortography during the procedure. After aortography tile deployment site was marked where the aortic intima teared, the stent - grafts 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 14 patients. As far as now there is no hospital mortality. Residual blood flow in the false lumen persisted in 2 patients, due to leakage at tile proximal end of the stent - graft. During follow - up 4 years ,no paraplegla,no arm weakness and late death occurred. Conclusion Stent -grafts is an important mean on type m aortic dissections,with less invasive,low complication rate and mortality, and less hospital stay.