急性胸降主动脉夹层的管腔内支架人工血管治疗

Treatment of acute descending thoracic aortic dissection with endovascular stent-grafts

目的 评价管腔内支架人工血管替代传统外科手术治疗急性期胸降主动脉夹层动脉瘤的可行性和治疗效果。方法 自 2 0 0 0年 3月至 2 0 0 2年 1月 ,采用管腔内支架人工血管治疗急性胸降主动脉夹层动脉瘤患者 2 0例 ,术前行胸部增强CT扫描。所用支架材料为国产形状记忆镍钛合金。结果 在 2 0例患者共放支架血管 2 2只 ,支架人工血管成功隔绝夹层原发破裂口 19例 (成功率为 95 % ) ,胸降主动脉受压夹层真腔全部恢复正常内径 ,无支架治疗导致的死亡。 1例病人手术后 6h因严重再灌注损伤死亡 (死亡率5 % ) ,转手术 1例 (转手术率 5 % )。术后 1个月之内行增强CT复查 ,并在术后 3月、 6月和 12月以及每年1次CT随访 ,未发现与支架人工血管有关的并发症。结论 管腔内支架人工血管治疗急性期胸降主动脉夹层动脉瘤具有良好的近期治疗效果 。

Objective To evaluate the efficacy of endovascular stent grafts on treatment of descending thoracic aortic dissection.Methods From March 2000 to January 2002,20 patients underwent operation of endovascular stent grafts in the descending thoracic aorta,and took chest angio computerized tomograhpy as preoperative assessment.Results 22 stent grafts were placed,and successful rate was 95%.All the compressed true lumen was restored to the normal size.There was no mortality related to the procedure,except one patient because of the severe reperfusion injury 6h postoperatively.Conclusion Endovascular stent graft may play a role in the treatment of acute descending thoracic aortic aneurysms,but a longer follow up is required. [