腔内隔绝术治疗Stanford B型主动脉夹层疗效观察

目的：回顾性总结主动脉腔内支架隔绝术治疗Stanford B型主动脉夹层动脉瘤的适应证、疗效和经验体会。方法：收集2007年6月－2013年3月本院胸心外科腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤42例患者的临床资料，术前采用CT血管成像、心脏超声等技术对主动脉夹层动脉瘤进行相关的评估，术中在DSA引导下采用覆膜血管支架封堵夹层原发破口，术后随访CTA。结果：42例移植物均成功释放。1例因手术中发现右侧股动脉细小，未能植入22#覆膜支架血管，给予保守治疗；1例因为术中见左椎动脉优势型，中途停止手术，改为血管置换、象鼻支架支架置入术。全组患者死亡1例；1例术后出现消化道出血；术后发生内瘘3例（包括1例术后并发主动脉食管瘘而死亡）；术后出现截瘫1例；1例再发主动脉夹层。其余随访患者术后未出现与动脉瘤及手术相关的并发症，总体生存质量较好。结论：腔内隔绝术治疗Stanford B型主动脉夹层具有良好的近中期疗效，远期疗效有待进一步研究随访；主要优点在于安全有效、创伤小、手术时间短、术后并发症少、恢复快等。内瘘是该疗法的主要并发症，其预后可能导致患者死亡。

Efficacy of Endovascular Graft Exclusion for the Treatment of Stanford Type B Aortic Dissection

Objective：To investigate the results of thoracic endovascular aortic repair（TEVAR）for Stanford type B aortic dissection. Method：The clinical data of 42 patients with Stanford type B aortic dissection aneurysm for the treatment of TEVAR were collected from June 2007 to March 2013 in the chest cardiac surgical. Preoperative CT angiography,cardiac ultrasound,intraoperative DSA-guided stent occlusion,postoperative follow-up of CTA was introduced to all patients. Result：42 cases of graft were successfully released;1 case was failed due to thin right femoral artery,could not implant 22 # coated stents blood vessels,than take conservative treatment;1 case because the left carotid surgery see arterial dominant type,was stopped surgery to graft replacement,trunk stent stenting. 1 case of perioperative was death;postoperative endoleak were found in 3 cases（included 1 case of postoperative aortic fistula and death）;1 case of postoperative gastrointestinal was bleeding;1 case of postoperative mediastinal esophageal fistula;1 cases of paraplegia was recorded;1 case of recurrence of aortic dissection. The overall quality of life were good. Conclusion：TEVAR treatment of Stanford type B dissection is good with early and mid-term results. The long-term effect needs further study. The internal leakage is a major complication of the therapy,the prognosis may lead to death.