主动脉腔内修复术救治胸主动脉破裂的临床观察

目的:探讨主动脉腔内修复术(TEVAR)救治胸主动脉破裂的临床适应证及疗效,并总结相关临床经验。方法:回顾性分析2006年1月—2015年9月因胸主动脉破裂急症在广州军区武汉总医院心胸外科就诊的患者临床资料。结果:检索出应用TEVAR救治程序收治的胸主动脉破裂患者51例(胸主动脉夹层动脉瘤破裂15例,胸主动脉创伤32例,主动脉食管瘘4例)。51例患者中,术前死亡4例,47例获TEVAR救治;术后死亡6例(其中主动脉食管瘘3例),其余41例患者均无明显严重并发症,且术后1个月内无死亡。术后3、6、12个月,之后每年复查CT,随访截至2016年5月,36例患者获得了完整的随访,随访6~123个月,平均56.6个月。其中1例随访至术后6个月,4例随访至术后12个月,1例随访至术后24个月。随访患者均健康存活、人工血管旁路通畅,血管支架无内漏。结论:TEVAR是快速、有效的救治胸主动脉破裂的一种措施。

Clinical observation of thoracic endovascular aortic repair for emergency treatment of thoracic aortic rupture

Objective: To investigate the clinical indications and effectiveness of endovascular aortic repair (TEVAR) emergency treatment of thoracic aortic rupture, and overview the relevant clinical experience. Methods: The clinical data of patients with thoracic aortic rupture admitted and treated from January 2006 to September 2015 in Department of Cardiothoracic Surgery, Wuhan General Hospital of PLA were retrospectively analyzed. Results: A total of 51 patients with thoracic aortic rupture (due to rupture of thoracic aortic dissecting aneurysm in 15 cases, thoracic aorta trauma in 32 cases and aortoesophageal fistula in 4 cases) who underwent emergency treatment of TEVAR procedure were retrieved. Of the 51 patients, 4 cases died during the initial treatment prior to TEVAR, and 47 cases received successful TEVAR operation; 6 cases (3 cases having aortoesophageal fistula) died after operation, while no serious complications occurred in the remaining 41 cases, in whom, no death occurred within postoperative one month. All cases were followed up at postoperative 3 months, 6 months and one year. By the end of May 2016, 36 cases received complete follow- up, the mean follow- up time was 56.6 months (range, 6 to 123 months); of these, the follow-up time after operation in one case was 6 months, in 4 cases was 12 months and in one case was 24 months. At follow-up, all the patients were in good health, and with no complications such as endoleak, stenosis or blockage of the bypass graft. Conclusion: TEVAR is a rapid and effective treatment modality for thoracic aortic rupture.