覆膜血管支架治疗Stanford B型主动脉夹层疗效观察

Endovascular stent-graft placement for the treatment of Stanford B type aortic dissections

目的 总结覆膜血管支架治疗Stanford B型主动脉夹层临床疗效以及围手术期的处理原则.方法 回顾性分析2004年12月至2009年8月40例因Stanford B型主动脉夹层行腔内隔绝术并放置覆膜血管支架患者的临床资料.结果 40例患者共置入41枚覆膜支架.39例（97.5%）获临床成功,围手术期内1例（2.5%）死亡,1例术中出现明显内漏,予球囊扩张,1例再置入1枚短支架后内漏消失.1例患者腔内隔绝术后急性心肌梗死,行冠状动脉急诊搭桥后患者存活.1例患者腔内隔绝术后移植物移位遂在体外循环下行胸主动脉替换术.1例患者术后左下肢脉搏消失,出院时下肢活动渐恢复正常.3例患者术后出现急性肾功能衰竭,对症处理后好转,2例患者术后出现肺部感染,根据痰培养更换抗生素后治愈.结论 覆膜血管支架对Stanford B型主动脉夹层的治疗具有创伤小、严重并发症少、住院时间较短的优势,近期疗效令人满意,远期疗效还有待于更长的随访.

Objective To investigate clinical therapeutic effects and management in peri-and post-operation of endovascular stent-graft exclusion for Stanford B aortic dissection. Methods From December 2004 to August 2009, 40 patients with Stanford B type aortic dissection were diagnosed by contrast-enhanced CT scan. Vascular access was obtained through the right or left femoral artery after arteriotomy and stent-graft was deployed into the true lumen to occlude the primary entry tear. Immediate aortography was performed after the procedure. Blood routine, renal function, blood-serumion, four limbs blood pressure, blood oxygen saturation after the procedure were monitored. Results Totally 41 stent-grafts were installed successfully in 40 patients. Thirty-nine patients were treated successfully, while 1 case（2.5%）died. Endoleak occurred in 2 cases immediately after operation. Endoleak disappeared in one patient after stent placement and one after balloon dilation. One with acute myocardial infarction after tent-grafts installed, survived after bypass operation of coronary artery. One survived after thoracic aorta replacement due to tent-grafts shift. One emerged left lower extremity asphygmia after operation, convalesced before discharge. Three cases with acute renal failure after operation, improved from aiti-sign management. Two cases had pulmonary infection and were cured after antibiotic adjustment. None postoperation paraplegia occurred.Conclusions Endovascular stent-graft placement of the Stanford B aortic dissection possesses the advantages of micro-invasive, less severe complication and shorter hospital stay that traditional threapy. The short-term efficacy is satisfactory.