微创外科治疗大动脉疾病

Minimally invasive approaches for treating disorders of the great vessels

目的 探讨胸主动脉疾病的微创治疗方法。方法 1999年 3月至 2 0 0 3年 3月在X线监视下 ,经股或髂外动脉 ,以微创法用血管腔内置入物治疗 112例大动脉疾病 ,包括夹层动脉瘤 95例 ,真性胸主动脉瘤 12例 ,主动脉减速伤 3例 ,主动脉狭窄 2例。结果 治疗均获成功。围手术期死亡 4例。发生近期内漏 6例 ,其中 4例经再次支架或弹簧圈置入治愈。后期内漏 2例 (因置入物移位和病变发展各 1例 ,给予相应治疗 )。随访 1～ 30个月 (平均 11个月 ) ,失访 10例 ,93例生存 ,3例死于与手术无关的疾病 ,另 1例多发性动脉瘤复发 ,在再治疗时死于严重的造影剂过敏。结论 微创方法治疗高风险的大动脉病变是相对安全、有效、可行的方法 ,具有良好的发展前景 ,但远期疗效尚待观察。

Objective: To explore the endoluminal graft treatment for disorders of the great vessels. Methods: From March 1999 to March 2003, under monitor of fluoroscope, 112 cases with the disorders of the thoracic aorta were treated by minimally invasive endografting method. The lesions include aortic dissection in 95 cases, thoracic aneurysm in 12, aortic deceleration injury in 3 and aortic stenosis in 2. Results: The technique success was obtained in all patients. The perioperative death occurred in 4 cases. Six cases had early endoleak, placing additional endograft or coils cured 4 of them. Two late endoleaks due to migration or new lesion formation were found and treated accordingly. After a follow-up of 1～30 months with average of 11 months, 93 cases were alive, 4 patients died of other causes unrelated to original disorders and one died of server allergy during the second treatment due to new lesion formation, 10 case lost. Conclusion: Using minimally invasive endografting therapy to treat disorders in the great vessels at high operative risk is relatively safe, effective and seems to have a prospective future, nevertheless, the long-term observation is mandatory, future although a long-term durability of graft remains to be proven.