覆膜支架腔内修复术治疗主动脉病变的价值

Value of transluminal stent-graft placement for the treatment of aortic disease

目的:评价覆膜支架腔内修复术治疗主动脉病变的应用价值及临床意义。方法:21例主动脉疾病患者,包括:Stanford B型夹层13例(65%),真性动脉瘤3例(15%),假性动脉瘤2例(10%),弓降部穿透性溃疡1例(5%),胸主动脉瘤合并局限性夹层1例(5%),胸主动脉瘤合并Stanford B型夹层1例(5%),全部接受TSGP。共应用3种类型大动脉覆膜支架,分别为:美国锐乐(10例)、国产先健(10例)及COOK公司血管支架(1例)。结果:17例分别置入1个支架,2例分别置入2个支架,2例分别置入主体支架1个、短支架2个,所有支架释放成功率100%。患者无截瘫及瘤体破裂等严重并发症,无围手术期死亡。支架释放后即刻造影复查,19例无明显渗漏和假腔显影(90%);2例少许内漏,其中1例术后7 d CTA复查内漏消失,1例为Ⅱ型内漏,建议随访观察;1例术后8月随访,支架近端新发内漏并逐次增多。结论:TSGP治疗主动脉夹层、真性及假性动脉瘤、穿透性溃疡成功率高、创伤小,近中期效果良好,但远期随访及效果评价有待进一步观察。

Objective： To investigate the feasibility of transiuminal stent-graft placement（TSGP） for the treatment of aortic disease. Methods： Aortic lesions included 13 （65 % ） type B dissections, 3 （ 15 % ） atheroselerotic aneurysms, 2 （ 10 % ） pseudoaneurysms, 1 （5% ） penetrating ulcer, 1 （5 % ） thoracic aorta with local dissection and 1 （5 % ） thoracic aorta with stanford B dissec- tion. Underwent TSGP using 3 types of grafts： US Relay-Made Stent-Graft （10 prostheses）, Domestic-Made Stent-Graft （10 prostheses） and COOK-Made Stent-Graft （1 prosthesis）. Results： Twenty-one stents were successfully implanted in 19 cases including 17 cases with 1 main stents and 2 cases with 2 main stents. Two cases were implanted with both main and cuff stents. Technical success was achieved in all patients. There was no severe procedure-related complication and accidents,such as paraplegia and angiorrhexis. There was no perioperative mortality. Nineteen cases had no leakage. Early leakage was observed in 2 patients. In one leakage resolved spontaneously when 7 days at postoperative CT angiography; in 1 case （type II）, it was managed with continued observation. One late leakage case was observed at 8 months after TSGP and treatment was converted to surgery. Conclusion： For the treatment of aortic dissection, atheroselerotic aneurysm, pseudoaneurysm and penetrating ulcer, TSGP has a high successful rate and less invasiveness, but further observation will be needed for evaluation of long-term results.