StanfordB型主动脉夹层腔内治疗临床分析

目的分析StanfordB型主动脉夹层腔内修复的治疗经验。方法总结2012年7月～2013年2月经腔内治疗7例StanfordB型主动脉夹层患者资料，所有患者均在计算机体层血管造影（Computedtomographyangiography，CTA）条件下确定诊断，在数字减影血管造影（Digitalsubtractionangiography，DSA）和全身麻醉条件下行腔内隔绝术。按照术后1个月、6个月、12个月的随访计划，观察瘤体形态学改变、治疗效果及并发症的发生情况。结果腔内技术成功率100％（7，7），临床成功率100％（7，7），术后住院期间无死亡患者，无左锁骨下动脉完全封闭，部分封闭2例，左锁骨下动脉烟囱支架2例，夹层累及腹腔干1例，肠系膜上动脉1例，累及一侧肾动脉2例，腹主动脉段存在远端破口2例，髂总动脉及髂外动脉存在远端破口1例。所有患者术后均未出现脑供血不足的临床表现，无截瘫情况发生，经过1个月、6个月及12个月的随访均正常存活，无新破口出现。结论StanfordB型主动脉夹层腔内治疗是一种有效方法，在血压控制平稳条件下，应尽快完成腔内修复治疗，对于夹层累及多个脏器动脉情况，应观察脏器血液灌注流速及流量，如有脏器严重缺血情况出现，应及时放置支架缓解血供，对于多个远端破口病例，应根据具体情况，在避免并发症的基础上尽早完成破口的封闭，并加强随访，观察病变处的动态变化。

Analysis of endovascular repair for Stanford B aortic dissection

Objective To investigate and summarize the experience of treating Stanford B aortic dissection by endovas- eular implantation of stent-grafts. Methods Computed tomography angiography was used to diagnose and aquire 7 eases with anatomical material of dissection. Stent-grafts of all patients were implanted on the condition of DSA and general anesthesia. Followed-up for 1 month,6 months and 12 months,and observed the complications, therapeutic efficacy and morphological changes of the aneurysms. Results The technical and clinical success rate were 100%. No deaths happened. Left subclavian artery （LSA） were covered partially in 2 patients and the funnels were then implanted to ensure the blood volume of left upper limb. Celiac trunk of 1 case, superior mesenteric artery of 1 case and unilateral renal artery of 2 cases were involved. 2 eases had distant tears of abdominal aorta. Common iliac artery and external iliac artery oceured in 1 case. There were no obvious cerebrolvascular insufficiency and paraplegia occurred. No deaths occurred after the follow-up of 1 month,6 months and 12 months. Conclusion Endovascular therapy was the effective measure of treating Stanford B aortic dissection. It should be done as soon as possible after stable blood pressure, implant stent-grafts if the splanchnie artery was involved by the dissection. For those patients that had other tears exited, endovascular implantation of stent-grafts should be done quickly according to spe- cific condition. Following-up should be strengthened to ensure the security of patients.