腔内隔绝术治疗主动脉夹层动脉瘤107例分析

Endovascular graft exclusion in treatment of aortic dissection aneurysm:a report of 107 cases

目的探讨应用覆膜支架腔内隔绝术治疗主动脉夹层动脉瘤的方法和效果。方法对107例(男88例,女19例,年龄28～83岁)主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析。术前采用CT血管成像(computerized tomography angiography,CTA)、经胸心脏超声(transthoracic echocardiography,TTE)、磁共振血管成像(magnetic resonance angiography,MRA)等技术对主动脉夹层动脉瘤进行评估。术中穿刺左肱动脉行主动脉造影了解破口的位置及撕裂的范围,在数字减影血管造影(digital subtraction angiography,DSA)监视下经股动脉将覆膜支架送入胸降主动脉封闭夹层破口。结果107例成功进行了主动脉夹层动脉瘤腔内隔绝术。术后主动脉造影证实夹层裂口完全封闭或内漏明显减少,无中转开胸手术。术后随访1～48个月,术后1个月3例死亡。104例行CTA复查,术后3个月,所有患者内膜破裂口封闭,胸降主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后6个月,1例再发生升主动脉夹层,置入一枚支架后后假腔消失。术后1年,主动脉均未见病变。结论覆膜支架腔内隔绝术是治疗主动脉夹层动脉瘤的安全、有效的方法,近期疗效好。手术死亡率和并发症发生率低,手术成功率和生存率高。

Objective To explore the technique and effects of endovascular stent-graft exclusion in the treatment of aortic dissection aneurysm.Methods Endovascular graft exclusion was performed in 107 patients with aortic dissection aneurysm（the range of age was from 28 to 83 years,88 male and 19 female）.Computed tomography angiography （CTA）,transthoracic echocardiography （TTE） and magnetic resonance angiography （MRA） were carried out as preoperative evaluation.The position and extent of the aortic dissection aneurysm were analyzed by angiography.The stent-grafts were inserted from the femoral artery to close the intimal tear,and all operations were performed under DSA guidance.Results Endovascular graft exclusions were successfully performed in all 107 patients.After the operation,angiography of the aorta showed that the intimal tear of the aortic dissection aneurysm was either excluded completely,or had obvious reduction in the inner leak.No patient had to appeal to thoracic surgery.The period of postoperative follow-up ranged form 1 to 48 months.One hundred and four patients received follow-up CTA.Three patients died within 1 month after operation.One patient had recurrent ascending artery dissection 6 months after the operation and required a second stent implantation to seal the intimal tear.Conclusion Endovascular graft exclusion is a safe and effective way to treat aortic dissection aneurysm with a low mortality rate and incidence of complications.