覆膜支架腔内隔绝术治疗胸主动脉夹层20例经验总结

目的总结应用覆膜支架腔内隔绝技术治疗胸主动脉夹层的经验。方法回顾性分析20例行覆膜支架腔内隔绝术治疗的胸主动脉夹层患者的临床资料，着重分析手术方法、手术结果、术后并发症和随访情况。结果20例手术即刻成功率为100％（20／20），术后住院（5．0±1．3）d。术后并发症包括1例行升主动脉至头臂干及左颈总动脉旁路术加支架植入，术后发生脑梗死，5例出现中度以上发热．1例出现肾功能衰竭，4例术后出现左侧胸痛，均经对症治疗后康复出院。随访CT检查1年-4年，未出现脊髓损伤、支架移位、锁骨下动脉窃血等，随访存活率为95％（19／20），1例术后半年支架末端与主动脉移行处的主动脉又出现动脉夹层，发生血管破裂死亡。结论覆膜支架腔内隔绝术是治疗Stanford B型和部分Stanford A型胸主动脉夹层的有效方法。

Experience of endovascular stent-graft exclusion for thoracic aortic dissection in 20 patients

Objectives To summarize the preliminary experience of endovascular stent-graft exclusion for aortic dissections. Methods We retrospectively analyzed the clinical data of 20 patiems with aortic dissections who underwent endovascular stent-graft exclusion, focused on the operation Methods , operation Results , complication and follow-up. Results The instant achievement ratio of the operation was 100% (20/20) and the postoperative stay time was (5.0±1.3) d. Complications after operation included 1 with cerebral infarction, 5 with midrange fever, 1 with renal failure and 4 with chest pain in left side. All of these patients were treated with symptomatic treatment and cured. After being followed up by CT for 1-4 years, no spinal cord ischemic injury, or stent displacement or subclavian steal syndrome happened in the 19 patients with the survival rate was 95% (19/20) , while, one patient died from vascular rupture due to new dissection near to the distal end of the stent. Conclusions Endovascular stent-graft exclusion is an effective procedure for patients with Stanford B type or some Stanford A tpye aortic dissection.