腔内隔绝术治疗Stanford B型胸主动脉夹层动脉瘤(附91例临床分析)

Endowascular Graft Exclusion for Stanford B Type Thoracic Aortic Dissecting Aneurysms:A Report of 9l Cases.

目的:探讨腔内隔绝术治疗Stanford B型胸主动脉夹层动脉瘤的手术指征、术前评估方法、手术操作技巧、并发症防治原则及临床应用前景.方法:回顾性分析本中心1998年9月至2001年7月间采用腔内隔绝术治疗91例Stanford B型胸主动脉夹层动脉瘤的经验.术前CTA或MRA显示:夹层动脉瘤最大直径为6.6mm±1.8mm(4.0～10.0mm);70例表现为单一夹层裂口,21例表现为多裂口.手术方法为经股动脉或腹主动脉将移植物导入胸主动脉封闭夹层裂口,手术在DSA监视下完成.结果:即时手术成功率为98.9%;70例单一夹层裂口病人中,62例使用了单一移植物,7例使用2个移植物,一例使用3个移植物;21例多夹层裂口者,8例使用2个移植物同时封闭不同部位夹层裂口,12例远端夹层裂口旷置,一例中转开胸手术;6例手术结束时残存Ⅰ型内漏;3例术后近期死亡,其余病例术后无心、肺、肾功能衰竭及截瘫等严重并发症.术后随访1～34个月,一例术后11个月猝死,2例分别于术后14个月和24个月再发Stanford A型胸主夹层瘤而行Bentall手术,其余病人未出现与夹层及手术相关的并发症.结论:腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤是一种创伤小、恢复快的新方法,短期的随访结果表明该技术安全、有效;内漏是该方法的主要并发症并可能导致病人术后即期死亡;该方法的远期疗效有待继续随访.

ve:To review the operative indications, preoperative evaluation, essentials in techno1ogy and c1i-nical prospect of Endovascu1ar Graft Exclusion for thoracic aortic dissecting aneurysm(s). Methods: Since Sep-tember 1998, the procedure was Preformed in 91 patients. Preoperative CTA or MRA showed the mean diameter ofthe aneurysms was 6.6mm±8.0mm(4.0~10.0mm), single tear was found in 70 patients and more than 1 tears werefound in the other 21 patients.Grafts constituted of self-expanding Z-stents covered with woven Dacron polyesterfabric. Graft dimensions were determined by spiral computed tomographic scanning. All operations were perfor-med under DSA guidance. Results: The grafts expended and were releaed successfully in 90 cases, one case wastransferred to laparotomy. Of the 70 cases with 1 tear, 62 cases were treated by placing 1 graft, 7 cases by 2 graftsand 1 case by 3 grafts; in the 21 cases with multiple tears, 8 used 2 grafts, 12 cases used 1 grafts. In 6 cases, theendoleaks persisted when the operation was over. There were 3 early deaths and 1 after 1l months. No complica-tions, such as myocardial infarction, lung failure, kidney failure or paralysis that occurred commonly after openoperations, were observed.Obturation of the 1eak(s) was achieved in all the cases, and the aneurysmal diameterwas decreased obviously during the follow-up. Conclusions: The early results of the Present study implicated thatEndovascular Graft Exclusion might be a safe and durable treatment for selected patients with thoracic aortic dis-secting aneurysm(s). Endoleak was the main complication that caused death after operation. Further follow-upstudy is proposed.