主动脉腔内隔绝术在Debakey Ⅲ型主动脉夹层治疗中的应用效果

Effects of endovascular graft exclusion on patients with Debakey type Ⅲ aortic dissection

目的探讨主动脉腔内隔绝术(EVGE)在DebakeyⅢ型主动脉夹层治疗中的应用效果。方法选取茂名市人民医院2015年7月至2018年7月收治的42例急性DebakeyⅢ型主动脉夹层患者为研究对象,所有患者均接受EVGE治疗,比较治疗前后瘤体、近端破口水平的真假腔直径测定值,并对其治疗效果、内瘘情况及预后效果进行评价和观察。结果42例患者共置入43枚支架,其中1例患者置入2枚支架。支架长度、支架直径、手术时间分别为(112.52±39.68)mm、(33.85±4.78)mm和(3.12±0.67)h,术中出血量为(66.98±27.54)ml;围术期无死亡患者。术后41例患者使用1枚支架完全隔绝,发生内漏1例,通过增加1枚支架进行处理后,内漏消失;1例出现脑梗死;1例出现血管粥样斑块脱落导致股动脉栓塞,切开股动脉取出脱落的粥样斑块后好转,无后遗症发生;1例术后出现高热,经对症治疗后好转。术后随访3次,与术前相比较,瘤体最大直径无显著增加(P>0.05),真腔增加明显(P<0.05),假腔直径减小(P<0.05)。结论DebakeyⅢ型主动脉夹层患者采用EVGE手术方法治疗,具有较高的安全性和可靠性。

Objective To investigate the effect of endovascular graft exclusion ( EVGE) in the treatment of Debakey type Ⅲ aortic dissection .Methods A total of 42 patients with acute Debakey type Ⅲ aortic dissection hospitalized in Maoming People’s Hospital from July 2015 to July 2018 were selected as the study subjects .All the patients were treated by EVGE .The measured diameters of true and false lumen in the proximal ruptures and aneurysms and were compared before and after treatment .And the therapeutic effect, internal fistula and prognosis were evaluated and observed .Results Forty-three stents were implanted in 42 patients, including two stents in one patient .The average length, diameter of stents and operation time were ( 112.52 ±39.68 ) mm, ( 33.85 ±4.78 ) mm and ( 3.12 ±0.67 ) h, respectively.The average bleeding volume during operation was (66.98 ±27.54) ml, and there was no death during perioperative period .After operation, 41 cases were completely isolated with one stent , however 1 case had internal leakage .After treatment, the internal leakage disappeared .One case had cerebral infarction.The femoral artery was embolized due to the loss of atherosclerotic plaque in one case.The femoral artery was cut to remove the exfoliated atherosclerotic plaque without sequelae .One case had high fever after operation and got recovery after symptomatic treatment .After 3 times of follow-up, the maximum diameter of the tumors did not increase significantly ( P>0.05), however, the maximum diameter of true lumen increased significantly ( P <0.05 ), and the pseudolumen diameter decreased significantly ( P<0.05).Conclusions EVGE is safe and reliable for patients with Debakey type Ⅲ aortic dissection .