降主动脉支架血管置入治疗Stanford B型主动脉夹层

目的 总结降主动脉人工支架血管置入术治疗Stanford B型主动脉夹层的临床治疗经验,并评价近期治疗效果.方法 对112例急性Stanford B型主动脉夹层患者,利用无名动脉插管、深低温停循环、顺行性脑灌注,实施降主动脉真腔人工支架血管置入术.结果 体外循环时间平均(89.3±5.8)min,主动脉阻断时间(35.9±4.7 )min,停循环顺行性脑灌注时间(14.7±2.1)min.1例76岁患者于术后1d死于多器官功能衰竭,其余111例患者均痊愈出院.术后出现一过性神经系统并发症23例,至出院时全部恢复正常;未发生截瘫病例;随访74例,6～52月,全部患者支架血管无移位和滑脱;47例患者降主动脉远端夹层假腔明显缩小、血栓形成.另外27例患者假腔没有明显变化,或仅有部分血栓形成.结论 降主动脉支架血管置入术治疗急性Stanford B型主动脉夹层,能够有效准确的封闭血管内膜破口,实现血管壁重建.

Descending Aortic Stent-graft Implantation for Treatment of Stanford B Aortic Dissection

Objective To summarize the experience and evaluate the clinical effects of surgical treatment of Stanford B aortic dissection using implantation of stent-grafts into descending aorta.Methods Stent-grafts were implanted into 112 patients with acute Stanford B type aortic dissection using innominate artery cannulation,deep hypothermia and circulation arrest technique.Results The mean cardiopulmonary bypass time was(89.3±5.8)min.The aortic clampping time was(35.9±4.7)min and the circulation arrest/antegrade cerebral perfusion time was(14.7±2.1)min.A 76-year patient died of multiple organ failure 10 days after surgery.The other 111 patients were fully recovered and discharged.A total of 23 patients showed transient neurological dysfunction after surgery and then recovered completely before discharge.No paraplegia occurred.Totally 74 patients were followed-up for 6-52 months and no movement or slipping of the stent was evidenced.Significant decrease of the false lumen was observed with thrombosis in the distal of descending aorta in 47 patients while no marked change of the false lumen was found in the other 27 patients.Conclusion Implantation of stent-grafts into descending aorta is an effective and safe surgical treatment for Stanford B type aortic dissection.