胸主动脉夹层覆膜支架腔内修复术的临床分析

Clinical analysis of transluminal stent-graft placement for thoracic aortic dissections

目的总结覆膜支架腔内修复术(TSGP)治疗胸主动脉夹层(TAD)的经验,探讨介入手术治疗的技术和方法。方法 9例胸主动脉夹层DeBakeyⅢ型患者,支架选用记忆合金自膨支架和超薄涤纶人工血管的复合体,直径根据螺旋CT血管造影(CTA)和主动脉数字减影血管造影(DSA)确定,在DSA引导下沿导丝经真腔将该覆膜支架封闭内膜破口和假腔。结果 9例共置入9个支架,覆膜支架置入后破口完全封闭,真腔血流恢复正常,无术中转开胸手术、截瘫等严重并发症,技术成功率100%。随访1～24个月,9例经胸片或CTA复查,证实无支架移位等严重并发症发生,术后康复良好。结论覆膜支架腔内修复术治疗胸主动脉层DeBaKeyⅢ型具有技术可靠、创伤小、术后恢复快、手术成功率和生存率高的优点。术前准确影像学评价,选择适当口径、长度的支架和术中准确定位夹层裂口和正确判断夹层真、假腔是介入治疗成功的关键。TSGP现已成为治疗胸主动脉夹层DeBaKeyⅢ型的新颖、高效、首选的治疗方法。

Objective To update the experience with transluminal stent-graft placement（TSGP） in treatment of thoracic aortic dissections（TAD） and to assess the interventional therapy technique and method.Methods Form May 2004 to December 2009,Deakey Ⅲ type TAD was found in 9 cases.Graft was self expanding stents covered with a woven Dacron polyester fabric graft.Graft dimensions and longitude were determined by spirad computerized tomographic angiography（CTA） and aortic DSA before TSGP.Along wire in the true cavity,the stent was put to closee the entry and false cavity of TAD under DSA guidance.Results 9 patients was placed 1 graft.All ruptures were completely closed and the blood flow returnted to normal in the true lumens,the successful rate was 100%.There was no death or serious complications at periopeastion.A follow up of 1-24 months was carried out,all cases were successful including the cases hat internal fistula.Conclusion TSGP with successful rate,low mortality and high survival rates is simple,and effective in Deakey Ⅲ type of TAD.The key points of successful TSGP are not only accurately preoperative evaluation of images and graft with suitable dimension and longitude but also accurately locate the entry and define the true cavity of TAD during operation.TSGP is a newer,safer and more effective choice for selected patients with TAD.