创伤性Stanford B型主动脉夹层腔内修复治疗6例临床分析

Endovascular treatment of traumatic Stanford type B aortic dissection: initial experience in six cases

目的探讨急性创伤性Stanford B型主动脉夹层的临床诊断和治疗的经验。方法回顾性分析2010年10月至2016年9月安徽医科大学第二附属医院收治的6例急性创伤性Stanford B型夹层患者的临床资料,所有患者均行胸腹主动脉计算机体层摄影血管造影(computed tomography angiography,CTA)以明确诊断,分析其临床特点和诊治经过。出院后进行随访,观察手术疗效。结果 6例患者均为男性,平均年龄为21~74岁,由交通事故(2例)或者高处坠落(4例)引起严重创伤,CTA检查均为Stanford B型主动脉夹层,4例行胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR),平均手术时间为87.5min,1例在发病后24 h死亡(围手术期死亡率16.7%),1例在发病后第1天自动出院并且失联。手术患者均无截瘫、脑梗死、左侧锁骨下动脉盗血等并发症。平均住院时间为18.8 d,出院后随访时间为3~6个月,手术患者复查CTA,均显示无内漏、支架移位,漏口封闭良好。结论 TEVAR是治疗急性创伤性Stanford B型主动脉夹层的有效方法。

Objectives To evaluate the clinical diagnosis and the treatment of acute Stanford type B aortic dissection caused by trauma. Methods The clinical data of 6 patients with acute traumatic Stanford type B dissection from October 2010 to September 2016 were analyzed retrospectively in the Second Affiliated Hospital of Anhui Medical University. All patients underwent computed tomography angiography （CTA） of the thoracic and abdominal aorta for confirming the diagnosis, then analyzed the clinical features, diagnosis and trealment The patients were followed up after discharge to observe the eurative effect. Results Six patients were males, aged from 21 to 74 years. Underlying causes were traffic accident （2 cases）and falling from the high （4 cases）. All cases were diagaosed to acute Stsnford type B aorlic dissection. 1 case was dead in first 24 h （perioperative mortality 16.7%）, 1 case was atomatic discharge and lost in the first day. 4 cases were performed by thoracic endovaseular aortic repair （TEVAR）, the average operative time was 87.5 minutes. No complications of paraplegia, cerebral infarction and left subclavian steal syndrome were reported. Average of charge was 18.8 days. CTA showed that no endoleakage or stem displacement occurred during the follow-up period for 3-6 months. Conclusion TEVAR is an effective method for the treatment of acute traumatic Stanford type B aortic dissection.