腔内隔绝术治疗112例Stanford B型主动脉夹层动脉瘤患者疗效观察

Observation on curative effect of endovascular repair of type B aortic dissection

目的评价主动脉夹层腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期临床疗效。方法选择行主动脉腔内隔绝术治疗Stanford B型主动脉夹层患者112例。经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后冠状动脉造影检查证实疗效,术后随访平均(39±18)个月。分析其临床特点及疗效。结果手术成功112例,共置入覆膜支架119枚。左锁骨下动脉完全被封闭8例,合并严重狭窄病变的冠心病患者完成PCI 16例,主动脉腔内隔绝术后综合征19例,术后1个月内夹层破裂死亡3例。随访3个月,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后明显残余内漏10例,3个月自行封闭。术后6个月,再发升主动脉夹层3例,其中行升主动脉外科手术1例,截瘫1例,胃癌多器官转移死亡1例。术后1年迟发性内漏1例。结论腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期疗效满意。

Objective To evaluate in-hospital and long-term curative effect of endovascular repair of type B aortic dissection by stent implantation. Methods From May 2002 to Jun 2008,112 patients with type B aortic dissection underwent stent implantation. The study included 85 men and 27 women with an age of（52± 16） years. All patients were followed up for average （39± 18） months. The clinical data of the patients were analyzed. Results The procedures were successful in all cases. After the procedure, left subclavian artery was totally occluded in 8 patients. The coronary intervention was performed in 16 patients with severe coronary heart disease. Transient post-implantation syndrome occurred in 19 patients. Three patients died in 30 days and one died of gastric cancer in half a year after operation. At three months, MRI or CTA demonstrated widely patent stent grafts and complete thrombosis of the false lumen in all patients, no evidence of migration or twisting of the stent graft was noted. Endoleak occurred in 10 patients and closed spontaneously after three months of follow-up. Ascending aortic dissection occurred in 3 cases and paraplegia in one case within 6 months after the procedure. Late endoleak occurred in 1 patient after one year. Conclusions In-hospital and long-term results showed that endovascular repair was effective in treatment of type B aortic dissection.