Standford B型主动脉夹层覆膜支架腔内修复术围手术期并发症分析

Transluminal stent-graft placement for Standford type B aortic dissections:an analysis of perioperative complications

目的总结覆膜支架腔内修复术治疗StandfordB型主动脉夹层的经验,分析围手术期并发症的发生率及处理方法。方法 2005年1月至2010年1月,127例B型主动脉夹层患者接受覆膜支架腔内修复术治疗。B型夹层112例,B型主动脉穿透性溃疡15例。术前、术后10d行64排CTA检查,证实手术效果。统计分析围手术期病死率、主要并发症发生率,探讨死亡及发生主要并发症的可能原因。结果手术成功率100%,围手术期死亡3例,病死率为2.4%,主要并发症发生率为13.4%(17/127),包括截瘫1例,逆行性A型夹层1例,脑梗死致意识障碍2例,支架相关并发症9例,严重内漏4例。结论覆膜支架腔内修复术治疗B型主动脉夹层安全、有效,但主要并发症的发生不容忽视。

Objective To summarize the practical experience of employing transluminal stent-graft placement in treating Standford type B aortic dissections,to analyze the perioperative complications and to discuss their management.Methods From January 2005 to January 2010,transluminal stent-graft placement was performed in 127 consecutive patients（106 males and 21 females,mean age of 50.8 years） with type B aortic dissection,of which Standford type B aortic dissection was confirmed in 112 and penetrating aortic ulcer in 15.Multi-slice CT angiography was carried out both before and after the treatment.The perioperative mortality and complications were recorded and analyzed.Results The perioperative mortality rate was 2.4%（3 /127） and the occurrence of major complications was 13.4%（17 /127）.Serious complications included paraplegia（n = 1）,retrograde type A dissection（n = 1）,disturbance of consciousness due to cerebral infarction（n = 2）,stenting-related complications（n = 9） and serious endoleak（n = 4）.Conclusion Transluminal stent-graft placement is a safe and effective treatment for Standford type B aortic dissection,nevertheless,the possible occurrence of life-threatening complications should not be ignored.