锥形覆膜支架治疗主动脉夹层动脉瘤疗效分析

A single-center's experience on clinical applyment of tapered design stent-graft in the treatment of aortic dissection

目的探讨锥形覆膜支架治疗主动脉夹层动脉瘤的疗效。方法于2012年2月—2013年6月间,随机选择60例真腔狭小的Stanford B型主动脉夹层患者,选用国产锥形覆膜支架系统进行腔内隔绝术并观察其疗效。结果技术成功率即支架植入成功率为100%,60例患者的第一破口完全封闭。术中出现轻度近端I型内漏12例(20%),未做处理,在3个月随访中自愈。术后反复胸痛3例,服用止痛药缓解,持续约6个月,其余患者术后即刻症状消失,内脏缺血症状改善。经随访,60例患者均存活,未发现远端逆撕破口,支架形态良好,假腔内大部分血栓形成,真腔逐步扩大。结论国产锥形覆膜支架系统减少了对远端内膜的损伤,尤其适用于真腔狭小的胸主动脉夹层病人,临床效果证明是安全、有效的,值得推广。

Objective To evaluate the clinical result of applyment of tapered design stent-graft in the treatment of aortic dissec-tion. Methods Random select 60 cases of Type B Aortic dissection with narrow true lumen using domestic tapered design stent-graft from February 2012 to June 2013. Results Technical success rate of stent implantation is the success rate was 100%, 60 cas-es of patients with first break were completely closed. A mild proximal type I endoleak was 12 cases （20%）, untreated, self healing at three months follow-up. Repeated postoperative chest pain in 3 cases, taking pain killers, lasted about 6 months, the symptoms disappeared in the rest of the patients immediately after the operation, visceral ischemia symptoms improve. During follow-up, 60 patients were alive, distal inverse tear break were not founded, the stent has good appearance, false lumen most of thrombosis, the true lumen gradually expand. Conclusions Domestic tapered design stent-graft can reduce the injury to the distal intimal layer which is especially suit for the patients with narrow true lumen. The results are safe and effective.