外科术中支架系统治疗Stanford B型主动脉夹层

目的:总结术中支架系统治疗Stanford B型主动脉夹层的临床经验。方法:67例Stanford B型主动脉夹层患者,在深低温停循环下,于左颈总动脉与左锁骨下动脉之间斜行切开部分主动脉前壁,直视下植入术中支架系统,封闭主动脉内膜原发撕裂口,扩大真腔、闭塞假腔,恢复远端血供。结果:体外循环时间114-190 min,平均(153±31)min,主动脉阻断时间22-42 min,平均(31±3)min,停循环时间12-25 min,平均(19±4)min。术后并发症:一过性脑功能紊乱8例;脑出血3例,出院时处于恢复期;血管吻合口出血开胸止血2例,其中1例死于多器官功能衰竭;声音嘶哑1例。术后复查CT:术中支架系统位置准确无移位,血流通畅,无内漏,降主动脉真腔较术前明显扩大,未闭降主动脉假腔血栓形成。结论:术中支架系统治疗Stanford B型夹层是安全、有效的。它能准确封闭血管内膜破口,实现血管壁的重建,简化手术,创伤小,并发症少,疗效确切。近期疗效令人满意,远期疗效有待进一步随诊。

Stent-Graft in Surgical Operation for the Treatment of Stanford Type B Aortic Dissection

Objective: To summarize the clinical experience on stent-graft in surgical operation for the treatment of Stanford type B aortic dissection.Methods: Sixty-seven patients with Stanford type B aortic dissection underwent surgery.Under deep hypothermic circulatory arrest,stent-graft in surgical operation was implanted through the aortic arch incision between the left carotid artery and left subclavian artery.The goals of the therapy were to cover the primary tear site,expand the true lumen with obliteration of the false lumen,and restore adequate flow and perfusion in the distal aorta.Results: Cardiopulmonary bypass time was(153±31) min(114-190 min),average cross clamp time was(31±3)min(22-42 min),and the duration of deep hypothermic circulatory arrest was(19±4) min(12-25 min).The complications included transient neurologic deficit in 8 cases,cerebrovascular accident in 3 cases,hemorrhage of anastomose which was treated by reoperation in 2 cases,and hoarseness in one case.Results: Stent-graft in surgical operation for the treatment of Stanford type B aortic dissection is safe,effective,and feasible,which will be helpful to vascular reconstruction by accurate covering the primary tear site with minimal invasion and less complications.