Stanford B型主动脉夹层覆膜支架腔内修复术近中期的疗效

Early and mid-term clinical efficacy of endovascular repair for Stanford B aortic dissection

目的评价覆膜支架植入术治疗Stanford B型主动脉夹层的近中期疗效及其安全性。方法选取2012年6月至2016年6月就诊的57例B型主动脉夹层患者,根据术前CTA影像学资料,选择合适的覆膜支架,在DSA透视下行腔内支架植入术,观察术中、术后及出院后3、6、12、24个月内并发症及其死亡率情况,分析其临床特点、疗效及随访结果。结果手术成功率为100%,植入支架位置理想,近端破口封堵满意,真腔血流恢复正常。术后平均住院时间11 d,1例术后3 d出现内漏,1例术后7 d死亡,1例13个月再发夹层,术后随访3~24个月,无术后卒中、截瘫,无支架近端再发逆行撕裂,无支架移位和破损发生。结论覆膜支架治疗Stanford B型主动脉夹层具有创伤小、安全、恢复快、操作简便、成功率高,并发症少,近中期疗效确切,随访病死率低的优势。

Objective To evaluate the early and mid-term clinical efficacy and safety of endovascular repair for Stanford B aortic dissection. Methods Fifty-seven patients with Stanford B aortic dissection from July 2012 to July 2016 were selected. Based on the preoperative CTA image data, the appropriate stent grafts were chosen, and then endovascular graft exclusion was performed under the DSA perspective. The complications and mortality 3,6, 12 and 24 months after tile operation were observed, and the clinical features, curative effect and follow-up results were analyzed. Results The success rate of operation reached 100% and the average length of hospitalization was 11 d. There were 1 case of postoperative 3 d leakage , 1 postoperative 7 d death and 1 of recurrent dissection 13 months later. Postoperative follow-up of 3 to 24 months showed that there were no postopera- tive paraplegia, no dislocated and regressive stents and no occurrence of transposition and breakage of stent. Conclusions Covered stent in the treatment of Stanford B aortic dissection has the advantages of less trauma, safety, rapid recovery, simple operation, high success rate, less complications, definite curative effect in early- and middle-term and low fatality rate.