主动脉夹层动脉瘤合并腹主动脉瘤的一期腔内治疗(附1例报告)

Endov as cular Stent-Graft Exclusion for the Treatment of Stanford B Type Aortic Disse ct ing Aneurysm Combined with Abdominal Aortic Aneurysm(A Case Report).

目的 :探讨胸主动脉夹层动脉瘤合并腹主动脉瘤病人作一期腔内隔绝术治疗的可行性、手术操作技巧及并发症防治原则。临床资料 :1例StanfordB型胸主动脉夹层动脉瘤合并腹主动脉及双侧髂动脉瘤的病人于 2 0 0 1年 2月在本中心接受了腔内隔绝术。术前CTA显示 :主动脉自弓降部开始出现夹层 ,一直延伸到腹主动脉分叉上6cm ,假腔的最大直径达 6 .6cm ;肾下腹主动脉瘤的最大直径为 4 .5cm ,瘤颈受夹层累及 ;双侧髂总动脉各有一直径 2 .5cm的真性动脉瘤。手术在全麻下进行 ,降主动脉植入规格为 34mm× 34mm× 1 30mm的直管型Talent移植物封闭夹层裂口 ;腹主动脉植入规格为 2 6mm× 1 4mm× 1 4 5mm的分叉型Talent移植物。将腹主动脉瘤和双侧髂动脉瘤隔绝 ,手术耗时 30 0min ,失血 30 0ml,透视 62min ,造影 5次 ,使用造影剂 2 0 0ml。术后病人恢复顺利 ,术后第 2天出ICU ,术后 30d出院。随访 1年 ,病人生活质量良好 ,复查CT示胸主动脉、腹主动脉瘤及髂动脉瘤完全封闭。结论 :腔内隔绝术的微创特点使一期治疗StandordB型主动脉夹层动脉瘤合并腹主动脉瘤成为一种比较安全的手术。术后应先处理胸主夹层处理腹主动脉瘤 。

To assess the te ch nical essentials and clinical prospective of Endovascular Stent-Graft Exclusion Proce dure for the treatment of thoracic aortic dissecting aneurysm combined wi th abdo minal aortic aneurysm. Methods: A 67-year old man under went th e procedure for his Stanford B type aortic dissecting aneurysm combined with abd ominal aortic aneurysm in February 2001. The preoperative CTA showed th at the te ar of the dissection originated from the descending aorta; and spread to the abd ominal aorta, the diameter of the false lumen of the dissection was 6 .6cm, the d iameter of the abdominal aortic aneurysm measured 4.5 cm, the neck o f the AAA wa s affected by the dissection, and the both the right and left cocmo n iliac arter ies were affected by aneurysms. The operation was performed under general anesth esia with DSA surveillance. A 34 mm×34 mm×145mm Talent tube was inserted into the descending aorta to occlude the tear of the dissection and a 26 mm×14 mm×1 45 mm bifurcated Talent graft was inserted to exclude the abdom inal aortic anury sm and the aneurysmal cocmon iliac arteries. The operation too k 300 minutes and the quantity of blood loss was 300ml. The patient recovered r apidly after operat ion, and was discharged 30 days after operation. He has now been followed up for more than a year, and CT shows that the dissection and AAA were excluded comple tely. Conclusions: The mini-invasive natu re of the endovascula r technique made the treatment for thoracic dissecting ane urysm and AAA during o ne single operation a safer procedure. During the operati on, the thoracic aortic dissecting aneurysm should be dealt with first in order to avoid disturbance to the later operation.