Stanford B型主动脉夹层的血管腔内治疗:附158例报告

Endovascular therapy for Stanford type B aortic dissections:a report of 158 cases

目的探讨Stanford B型主动脉夹层血管腔内治疗的方法和效果。方法回顾分析6年间收治的158例急、慢性Stanford B型主动脉夹层患者血管腔内治疗的临床资料。急诊手术19例,限期手术139例。术后定期复诊,动态观察主动脉的变化。结果支架释放后即刻造影显示第一破口封堵率为92.4%。22例并发胸腔积血的患者,9例并发急性肾功能不全患者,13例并发肠系膜上动脉缺血患者,5例并发下肢动脉缺血患者,3例慢性夹层动脉瘤瘤腔巨大患者均于术后达到临床治愈标准。19例非左侧椎动脉优势患者术中直接封堵左锁骨下动脉后均未出现窃血综合征。住院期间无死亡。141例获得3～48个月的随访,2例存在持续内漏,1例因支架移位再次手术并获得成功,1例并发脑梗死患者恢复良好。结论Stanford B型主动脉夹层患者在进行血管腔内治疗后近期、中期内观察疗效确切,是一种有效的治疗方法。

Objective To evaluate the methods and results of endovascular therapy for Stanford type B aortic dissection. Methods A retrospective review was conducted of 158 patients with Stanford type B aortic dissection who were treated with endovascular therapy in the past six years. There were 19 cases of emergency operation and 139 cases of elective operation. Fellow-up was performed regularly after operation. Aortas were dynamically observed. Results After the stent-graft implantation, 92.4% blockade rate of the first tear of the Stanford type B aortic dissection was obtained. After operation, 22 cases were complicated by hemothorax, 13 cases by ischemia of superior mesenteric artery, 9 cases by acute renal insufficiency, and 5 cases by ischemia of artery of lower extremity. Three cases of huge chronic dissection aneurysm achieved clinical cure after operation. No subclavian steal syndrome occurred in the 19 cases whose left subclavian artery was sealed by the stent-graft during operation. There was no hospital death. One hundred and forty-one cases were followed up for 3 - 48 months. Continuous endoleaks were found in 2 cases; 1 case of the stent-graft migration was successfully treated after another stent-graft implantation; and 1 case of cerebral arteries infarction recovered well. Conclusions Endovascular therapy is safe and effective for the patients with Stanford type B aortic dissection in the early and mid-term periods of postoperation.