腔内隔绝术治疗Stanford B型胸主动脉夹层18例

Endovascular graft exclusion for 18 cases with Stanford type B aortic dissections

目的分析腔内隔绝术治疗Stanford B型胸主动脉夹层的效果和难点。方法 2006年1月至2008年12月共对18例胸主动脉夹层患者进行腔内隔绝术治疗,手术时间均选择急性发病1周以后,对于难于判断夹层真假腔的患者采用局部撕裂内膜片切线位主动脉造影法。观察手术成功率,手术并发症,住院期间及随访期间疗效。结果 18例患者全部成功植入支架共19枚,随访1年生存率100%,术后造影剂肾病1例,术后半年因腹主动脉夹层接受外科手术1例。结论胸主动脉夹层覆膜支架腔内隔绝术是一项微创、安全的治疗手段,采用局部内膜片切线位主动脉造影法能够更有效的判断夹层真假腔。

Objective To analyse the effectiveness and nodus of interventional treatment in patients with thoracic aortic dissection by endovascular graft exclusion.Methods From January 2006 to December 2008,18 patients with Stanford B aortic dissection received endovascular graft exclusion in our centre.All patients received operation at least 1 week after aortic dissection occured.The aortic angiography with the tangential projection view of tearing endomembrane was adopted in patients whose true lumen and false lumen were difficult to determine.The operation achievement ratio and complications,the effectivesss of treatment in hospital and follow-up were observed.Results Stent-grafts were successfully performed in all cases.Mean follow-up was 1 year.The overall survival rate at 1 year was 100%.Radiographic contrast nephropathy was occurred in 1 case,1 patient received open operation for abdominal dissection half a year after endovascular graft exclusion.Conclusion Endovascular repair with stent-graft was safe and effective for the treatment of Stanford type B aortic dissections.Using tangential projection view of tearing endomembrane is a feasible way to distinguish the true and false lumen.