覆膜支架腔内隔绝术治疗胸主动脉夹层20例经验总结

Experience of endovascular stent-graft exclusion for thoracic aortic dissection in 20 patients

目的总结应用覆膜支架腔内隔绝技术治疗胸主动脉夹层的经验。方法回顾性分析20例行覆膜支架腔内隔绝术治疗的胸主动脉夹层患者的临床资料,着重分析手术方法、手术结果、术后并发症和随访情况。结果20例手术即刻成功率为100%(20/20),术后住院(5.0±1.3)d。术后并发症包括1例行升主动脉至头臂干及左颈总动脉旁路术加支架植入,术后发生脑梗死,5例出现中度以上发热,1例出现肾功能衰竭,4例术后出现左侧胸痛,均经对症治疗后康复出院。随访CT检查1年～4年,未出现脊髓损伤、支架移位、锁骨下动脉窃血等,随访存活率为95%(19/20),1例术后半年支架末端与主动脉移行处的主动脉又出现动脉夹层,发生血管破裂死亡。结论覆膜支架腔内隔绝术是治疗Stanford B型和部分Stanford A型胸主动脉夹层的有效方法。

Objectives To summarize the preliminary experience of endovascular stent-grafi exclusion for aortic dissections. Methods We retrospectively analyzed the clinical data of 20 patiems with aortic dissections who underwent endovascular stent-graft exclusion, focused on the operation methods, operation results, complication and follow-up. Results The instant achievement ratio of the operation was 100% （20/20） and the postoperative stay time was （5.0±1.3） d. Complications after operation included 1 with cerebral infarction, 5 with midrange fever, 1 with renal failure and 4 with chest pain in left side. All of these patients were treated with symptomatic treatment and cured. After being followed up by CT for 1-4 years, no spinal cord ischemic injury, or stent displacement or subclavian steal syndrome happened in the 19 patients with the survival rate was 95% （19/20） , while, one patient died from vascular rupture due to new dissection near to the distal end of the stent. Conclusions Endovascular stent-graft exclusion is an effective procedure for patients with Stanford B type or some Stanford A tpye aortic dissection.