DeBakeyⅢ型主动脉夹层腔内修复治疗并发症的处理与分析

Management of complications after endovascular repair for De Bakey type III aortic dissection

目的总结近年来我科DeBakey III型主动脉夹层腔内修复治疗的经验，重点探讨围术期发生的并发症及其预防与处理。方法回顾性分析自2009年1月至2011年1月的2年间我科完成49例DeBakey III型主动脉夹层腔内修复治疗患者的临床资料。结果无术后近期死亡、无截瘫。严重的并发症有昏迷2例（4．1％）、内漏2例（4．1％）、上肢缺血2例（4．1％）。新发近端夹层1例。术后多数患者存在不同程度发热。结论腔内修复治疗能够降低夹层治疗的病死率，但严重并发症不容忽视。降低逆行性夹层、急性脑供血不足、内漏等并发症可以进一步改善患者的预后，提高生存质量。

Objective To summarize the experience in endovascular repair of De Bakey type III aortic dissection in recent years and summarize the prevention and management of the related perioperative complications. Methods From January 2009 to January 2011,49 cases of endovascular repair for De Bakey type III aortic dissection were performed under general anesthesia in our department. There were 45 male and 4 female. The follow-up was performed in the outpatient department or by telephone. Results There was no inhospital death and no paraplegia events. Severe complication included ： coma, 2 cases （ 4. 1% ） ; endoleak, 2 cases （4. 1% ） ; upper limb ischemia, 2 cases （4. 1% ）. Recurrent proximal aortic dissection, 1 case. Fever was occurred in most of those cases. Conclusion Endovascular repair of aortic dissection improves the outcome of aortic dissection patients. But more attention should be pay to prevent the severe complications. It will help to improve the prognosis and life quality by reducing the risk of retrograde dissection, acute brain ischemia and endoleak.