胸主动脉夹层合并腹主夹层动脉瘤的一期腔内治疗

Endovascular stent-grafts in the exclusion for Stanford Type B aortic dissection combined with abdominal aortic dissecting aneurysm

目的：探讨胸主动脉夹层动脉瘤合并腹主动脉夹层动脉瘤病人一期腔内隔绝术治疗的可行性、手术操作技巧及并发症防治原则。方法和结果：1例Stanford B型胸主动脉夹层动脉瘤合并腹主动脉夹层动脉瘤及双侧髂动脉瘤的病人于2006年3月在本中心接受了腔内隔绝术。MRA检查提示,主动脉弓降交界处开始出现夹层,真腔受压变窄,以胸腹交界处及腹主动脉中段最明显,最扁窄处为0．5 cm；假腔在腹主动脉中段明显,最大径约5．0 cm,假腔再入口位于左髂总动脉近端。双侧髂总动脉迂曲并呈瘤样扩张。腹腔干、肠系膜上动脉及双侧肾动脉均发自真腔。手术在全麻下进行：降主动脉植入规格为34-34-100 mm的直管型Talent移植物,封闭夹层裂口；腹主动脉植入规格为AOI 26-12-170 mm Talent移植物,远端连接12-12-68 mm Talent移植物至一侧髂外动脉,行双侧股-股转流。瘤体隔绝完全,手术约耗时300 min,失血1000 ml,透视6 min,使用威视派克450 ml。术后21 d出院。术后随访半年,病人生活质量良好,复查CTA显示：移植物通畅,瘤腔内均完全形成血栓。结论：腔内隔绝术的微创特点使一期治疗Stanford B型主动脉夹层动脉瘤合并腹主动脉瘤成为一种比较安全的手术。主动脉长段隔绝也有利于降低截瘫的发生率。

Objective To assess the feasibility of endovascular graft exclusion technique in treating thoracic aortic dissection combined with abdominal aortic aneurysm（AAA）. Mathods and Results A 79 years old patient was submitted to endovascular therapy for Stanford Type B aortic dissection combined with abdominal aortic dissection aneurysm in March 2006. The preoperative MR angiography demonstrated that the dissection originated from the descending aorta and spread to the abdominal aorta. The abdominal aortic aneurysm was 5.0 cm in diameter, the neck of the AAA was affected by the dissection, and both common iliac arteries were also aneurysmal. The operation was performed under general anesthesia and DSA surveillance. A 34-34-100 mm tube Talent graft was inserted into the descending aorta to block the tear of the dissection; an AOI 26-12-170 mm Talent graft into the abdominal aortic aneurysm, with an 12-12-68 mm extension into the external iliac artery. The operation time was 300 minutes and the volume of blood loss was 1000 ml. The patient recovered uneventfully and was discharged 21 days after operation. Thereafter, the patient has been followed up for 6 months and CT angiography indicated that the dissection and aneurysms were completely excluded. Conclusions Endovascular technique is a minimally invasive and safe procedure in treating Stanford Type B aortic dissection combined with AAA.