腔内隔绝术治疗Stanford B型主动脉夹层23例临床分析

Transluminal placement of endovascular stent-graft for the treatment of Stanford B type aortic dissections:a report of 23 cases

目的探讨StanfordB型主动脉夹层动脉瘤腔内隔绝术治疗的手术指征、术前评估方法、手术操作技巧、并发症及防治原则;观察近、中期临床疗效。方法自2003年3月～2006年1月,对23例StanfordB型主动脉夹层动脉瘤患者行腔内隔绝术治疗,笔者对临床资料进行回顾性分析。术前采用CT血管造影(CTA)或磁共振血管造影(MRA)对主动脉夹层动脉瘤进行评估,术中在数字减影血管造影(DSA)监视下经股动脉将移植物导入胸主动脉封闭夹层裂口,术后行影像学及症状学随访观察。结果术中成功释放移植物22例,术后即刻DSA造影显示18例近段破口完全被封闭,动脉瘤消失,4例发生内漏,其中2例再次置入支架后内漏消失。术后2例患者发生腹主动脉夹层,其中1例再次行腔内隔绝术。1例患者发生肠系膜动脉栓塞引起肠坏死而死亡。22例患者术后无心、肺、肾功能衰竭及截瘫等并发症,术后生命体征平稳,切口愈合,出院,术后经过CTA及症状学随访显示无严重并发症,生活质量明显提高。结论腔内隔绝术是一种创伤小、恢复快的新方法,近、中期随访结果表明该技术安全、有效。

Objective To study the surgical indication, preoperative evaluation, operation technique, complications, management principles, short-term and mid-term therapeutic effect, on endovascular stent-graft placement in Stanford B type aortic dissections. Methods Endovascular stent-graft placement （EVGP） for treatment of Stanford B type aortic dissections was performed in 23 patients during March 2003 to January 2006. The CT angiography or MR angiagraphy was adopted as preoperative evaluation measures. The stent-graft was inserted placed onto the thoracic aortic dissection via femoral artery under the monitoring of DSA guidance. Results The grafts were installed successfully in 22 patients. In 18 patients the proximal tears were occluded successfully; 4 patients occurred endoleak and 2 of them endoleak disappeared after installing another stent graft; 2 patients occurred abdominal aortic dissection, 1 of them reoperated by transluminal placement of stent graft and 1 patient died from mesentric artery embolism. Twenty-two patients had improved life quality. Accidents related to the operation and dissection were not found. Conclusion The short-term and mid-term follow-up study demonstrated that endovascular stent graft placement is a minimally invasive, save and effective approach in treating Stanford B type aortic dissections.