胸腹主动脉夹层动脉瘤(Stanford B型)的腔内血管外科治疗

Endovascular technique for Stanford B type aortic dissection

目的 探讨StanfordB型胸腹主动脉夹层动脉瘤腔内治疗的方法。方法 对 12例StanfordB型胸腹主动脉夹层动脉瘤患者的临床资料进行回顾性研究。结果 12例患者全为男性 ,年龄 40～ 68岁 ,平均 5 2 .1岁。其中 10例患者进行了腔内血管外科治疗 ,均取得了技术上的成功 ,术后内漏 1例 ,3d后漏血停止。其余病例术后即时造影示瘘口已被完整覆盖 ,假腔无血漏入 ,内脏动脉等恢复真腔供血。 2例未行腔内治疗的患者 ,1例因并发呼衰死亡 ,1例死于夹层动脉瘤破裂。结论 对StanfordB型胸腹主动脉夹层动脉瘤的治疗 ,如适应证掌握合适 ,腔内治疗与传统的开胸手术相比 ,具有操作简单 ,损伤小 ,安全度大 ,并发症少等优点 ,且可大大缩短患者的住院时间。保守治疗难以控制病情的发展 ,易导致死亡等严重后果。

Objective To explore the effect of endovascular treatment on Stanford type B aortic dissection. Methods The clinical data of 12 cases of Stanford type B aortic dissection were analysed retrospectively. Results All the cases were male, the age ranged from 40-68 years with a mean of 52.1 years. Among the 12cases, 10 patients underwent endoluminal treatment, the instant technique was successfully performed in 10 patients. Endoleak happened in 1 case because of the stent-graft deployment, but automatically stopped 3 days later. In other 9 patients, Angiography after the operation showed that all the rupture areas were sealed completely, and the celiac arteries blood supply were recovered via the true lumen and no blood stream was shown in the false cavity. 2 patients received conservative treatment died, one died of failure of respiration and another died of rupture of the dissection. Conclusions In the treatment of Stanford B type aortic dissection, if the selection of the patient is correct, endoluminal technique is much simple, safe, less trauma, and less complications as compared to the traditional operation, and it can also shorten the hospital stay of the patient. Conservative treatment can not control the development of the diseases, and easily results in death of the patient.