覆膜支架治疗DeBakeyⅢ型主动脉夹层的临床研究

Clinical study of covered stent in treating Debakey Ⅲ type aortic dissection

目的研究覆膜支架治疗De BakeyⅢ型主动脉夹层的临床效果,为其临床治疗提供科学依据。方法选取2013年1月~2014年12月收治的30例经确诊且进行覆膜支架治疗的DaBakeyⅢ型主动脉夹层患者和30例进行传统分支人工血管治疗的DaBakeyⅢ型主动脉夹层患者,为别设置为观察组、对照组。回顾性分析这60例DaBakeyⅢ型主动脉夹层患者的临床资料,研究其手术治疗方法 ,比较两组患者的手术成功率、死亡率、体外循环时间、阻断时间、选择性脑灌注时间、术后24 h引流量、住院时间及随访情况。结果两组患者的手术成功率、死亡率比较,差异无统计学意义（P〉0.05）。观察组的体外循环时间、阻断时间、选择性脑灌注时间、住院时间均明显短于对照组（P〈0.05）,观察组的术后24 h引流量明显少于对照组（P〈0.05）。术后短期随访资料显示,观察组和对照组中手术成功且有效存活的患者行磁共振复查发现,主动脉夹层内的假腔减小、形成血栓,真腔明显增大,且均未出现并发症。结论覆膜支架手术治疗DaBakeyⅢ型主动脉夹层具有显著的近期治疗效果,且其并发症少、安全性高,但其远期疗效有待进一步探讨。

Objective To study the clinical effects of covered stent in treating Debakey Ⅲtype aortic dissection,and to provide scientific basis for clinical treatment of Debakey Ⅲ type aortic dissection.Methods 30 Debakey Ⅲ type aortic dissection patients who diagnosed and treated with covered stent and 30 Debakey Ⅲtype aortic dissection patients who treated with traditional branch artificial blood vessel from January 2013 to December 2014 were selected and were divided into observation group and the control group.Retrospective study method was used to study the clinical data of 60 Debakey Ⅲtype aortic dissection patients.The surgery method of them was studied,and the surgical success rate,mortality,extracorporeal circulation time,blocking time,selective cerebral perfusion time,induced flow volume in postoperative24 h,hospital stays and follow up in two groups were compared.Results The difference of surgical success rate and mortality between two groups had no statistical significance（P〈0.05）.The extracorporeal circulation time,blocking time,selective cerebral perfusion time and hospital stays in observation group was obvious shorter than that of control group respectively（P〈0.05）,and induced flow volume in postoperative 24 h in observation group was lower than that of control group（P〈0.05）.Postoperative short term follow-up data showed that the patients with successful surgery and survival in observation group and control group conducted nuclear magnetic resonance reviewed founded,the false lumen in aortic dissection decreased,the thrombosis formation and true lumen obvious increased,and any complications appeared.Conclusion In the clinical treating of Debakey Ⅲ type aortic dissection,using covered stent treatment with obvious recent therapeutic effect,and with little complications and high safety.But the long term effects of covered stent in treating Debakey Ⅲtype aortic dissection needs further discussion.