腔内隔绝术联合胸腔引流治疗胸降主动脉不完全破裂合并胸腔积血9例临床分析

Endovascular graft exclusion combined with chest tube drainage in treatment of thoracic aortic rupture incompletely merged with left hemothorax

目的探讨胸降主动脉不完全破裂合并大量胸腔积血行腔内隔绝术联合胸腔置管引流治疗的疗效及安全性。方法收集2002年4月至2013年12月沈阳军区总医院收治的胸降主动脉不完全破裂合并左侧大量胸腔积血伴严重呼吸困难者9例。冠状动脉及主动脉造影后,经股动脉切开植入覆膜支架封堵胸降主动脉夹层破口或隔绝胸降主动脉瘤。观察患者腔内隔绝术联合胸腔置管引流治疗的疗效、病死率、远期预后。结果主动脉腔内隔绝术成功率为88.9%(8/9),共植入9枚主体覆膜支架及1枚短体覆膜支架。1例术中植入腹膜支架后主动脉破裂死亡,2例部分封闭左锁骨下动脉开口,1例术后有少量残余漏。1例术后36 h因主动脉破裂死亡,7例顺利出院。术后平均随访(69±29)个月。随访期间1例出现脑出血,遗留右侧肢体活动不灵,1例出现猝死(死因不详),余5例均术后恢复良好。结论主动脉腔内隔绝术联合胸腔置管引流治疗合并左侧胸腔积血的不完全破裂或频临破裂的主动脉扩张性疾病,近期及远期疗效显著,抢救成功率高,并发症少。

Objective To evaluate the curative effect and safety of endovascular graft exclusion combined with chest tube drainage on thoracic aortic rupture with left hemothorax. Methods From April 2002 to December 2013,61 patients were diagnosed with thoracic aortic rupture incompletely merged with left hemothorax in Shenyang Northern Hospital. Nine patients suffered from massive hemothorax accompanied with serious dyspnea. The stent grafts were implanted through the femoral artery incision and covered the thoracic aortic dissecting or isolated the aneurysms. The aortic angiography was to ensure the curative effect. Observation included the curative effect and mortality. Results The success rate of endovascular graft exclusion was 88. 9%（ 8 /9）. Nine mainly covered stents and 1 short covered stent were implanted. One patient died of aortic rupture after intraoperative implantation,2 patients had partial closure of the left subclavian artery,and 1 patient had a small amount of residual leakage. One patient died of aortic rupture 36 hours after the operation,and 7 patients discharged.The average time of postoperative follow-up was（ 69 ± 29） months. One patient appeared to have cerebral hemorrhage with ineffectiveness of the right side of the body and 1 patient died without known causes. The other 5 patients were stable with good postoperative recovery. Conclusion It is both long-term and short-term effective with high success rates and few complications to treat thoracic aortic rupture incompletely merged with left hemothorax or near rupture in dilated aorta diseases by endovascular graft exclusion combined with chest tube drainage.