Stanford B型主动脉夹层的腔内治疗（附134例报告）

目的探讨腔内胸主动脉修复术治疗Stanford B型夹层的临床价值。方法对我院2006年1月～2011年8月134例行腔内胸主动脉修复术的B型主动脉夹层患者的治疗情况进行回顾性分析。男93例,女41例。年龄32～82岁,（56.4±8.3）岁。全麻,数字减影动脉造影（digital subtraction angiography,DSA）监控下,切开股动脉,将带膜支架置于胸主动脉内膜破口处封堵破口。结合术前影像学、术后门诊影像学随访资料,观察夹层病变演化过程,观察有无内漏、移位和人工血管内支架塌陷等术后并发症。结果 134例原发胸主动脉夹层破口均完全封闭,真腔血流恢复,原受损脏器功能恢复正常。释放支架165枚。围手术期死亡2例,随访死亡1例。90例获得随访,随访时间3～63个月,（25.6±8.4）月,主动脉CT血管成像（CT angiography,CTA）复查显示无内漏、移位等并发症。12例支架尾部破口,再次行腔内隔绝,1例术后逆行性A型夹层。结论腔内胸主动脉修复术治疗Stanford B型夹层具有技术可靠、安全性高、术后恢复快等优点,临床应用前景良好。

Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Objective To evaluate thoracic endovascular aortic repair for type B aortic dissection.Methods We retrospectively reviewed the data of 134 cases of type B aortic dissection,who underwent endovascular aortic repair in our hospital from January 2006 to August 2011.Among the cases,93 patients were male,and 41 were female;the mean age of the patients was(56.4±8.3) years(ranged from 32 to 82).Under general anesthesia and guidance by DSA,we cut the femoral artery and placed a membrane-covered stent to block the aortic rupture.The patients were followed up with imaging examination at outpatient department.We compared the pre-and postoperative imaging results,and monitored the possible complications such as endoleak,and migration and fracture of the stent-graft.Results In all the cases,the aortic dissection tears were closed,true lumens were opened,and organ functions were restored.Totally 165 stents were placed.Perioperative death occurred in two patients,and postoperative death happened in one.Follow-up was achieved in 90 patients for a mean of(25.6±8.4) months(3-63 months).During the follow-up,CT angiography showed no endoleak or stent displacement.A second endovascular aortic repair was performed on 12 patients because of a breach in the end of the stents.One patient developed retrograde type A dissection after the operation.Conclusion Endovascular aortic repair is safe and effective for Stanford type B aortic dissection.It has a promising future in clinical practice.