腔内治疗19例Stanford B型主动脉夹层的临床分析

Thoracic endovascular aortic repair for Stanford B dissection in 19 cases

目的:总结19例Stanford B型主动脉夹层(AD)腔内修复术(TEVAR)的治疗经验。方法:回顾分析19例行腔内治疗的Sanford B型AD病例,其中单纯行TEVAR 17例,颈-颈转流加TEVAR手术2例。结果:19例AD患者均得到随访,随访时间3个月~3年;术中即刻内漏11例,经球扩和随访后消失;围手术期死亡1例,考虑主动脉夹层术后近端逆撕引起;术后1例上肢乏力,7例术后存在不同程度发热;术后胸腔积液增多2例,术后第3天出现1例,术后半年出现1例;2例杂交手术患者人造血管通畅;随访发现腹主动脉段新发破口2例。结论:TEVAR治疗Stanford B型AD疗效明确,能够降低夹层治疗的病死率,但严重并发症不容忽视;降低逆行性夹层,注意术后胸腔积液的变化、内漏等并发症可以进一步改善患者的预后。

Objective:To summarize the clinical experiences of thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(AD)in 19 patients.Methods:Clinical data were reviewed in 19 cases of AD,in whom 17 underwent simple TEVAR,and 2 carotid-carotid bypass and TEVAR.Results:All patients were followed up for 3 months to 3 years.Intraoperative immediate endoleak occurred in 11 cases,and were managed with balloon dilation.Perioperative death occurred in one patients as a potential result of retrograde type dissection.One patient had upper limb weakness,and 7 had varying degrees of fever after operation.Increased pleural effusion occurred in one patient three days after surgery,and in another one six month following operation.Vascular prostheses patency achieved in 2 cases undergone hybrid surgery.New entry of abdominal aorta was found in 2 cases during follow-up.Conclusion:TEVAR is effective for Stanford type B aortic dissection,and potentially reduces the case fatality rate.However,serious complications can not be ignored,and preventing the retrograde dissection,careful attention to the incidence of postoperative pleural effusion and ndoleaks as well as other complications may improve the prognosis of AD.