“象鼻”手术治疗覆膜支架腔内修复术后近端逆行剥离新发破口

目的:探讨覆膜支架腔内修复术(TSGP)后支架近端逆行剥离、新发破口的手术方式和治疗经验。方法:2009年3月至2011年5月,6例TSGP术后支架近端逆行剥离、新发破口的患者,于北京安贞医院接受手术治疗。6例患者均为男性,年龄32～62岁,均为TSGP术后随访期慢性病例。其中1例行传统象鼻手术;其余5例行支架象鼻手术。2例合并主动脉弓夹层的患者同期行主动脉弓替换。结果:术后均痊愈出院,无住院死亡。无脑部及脊髓等神经系统并发症。1例患者因术前肾功能不全,术后出现急性肾衰竭,术后透析后痊愈。随访1～26个月,1例采用传统软象鼻手术技术的患者,软象鼻远端和介入支架仍有血流逆行灌注假腔,引起假腔持续增大。2年后,于软象鼻内再次置入介入支架闭合假腔破口。其余5例采用支架象鼻手术技术的患者,破口完全闭合,假腔内血栓形成,术后效果好。结论:象鼻手术是治疗TSGP术后支架近端逆行剥离、新发破口的有效方法;其中支架象鼻手术优于传统软象鼻手术方式;如合并主动脉弓夹层,同期行主动脉弓替换术。

Surgery for retrograde stripping following TSGP with the elephant truck technique

Objective:To explore the surgical techniques and clinical experiences in treating retrograde stripping following Transluminal Stent-graft Placement(TSGP).Methods:From March 2009 to May 2011,elephant truck technique was performed in six patients with retrograde stripping following TSGP in Beijing Anzhen Hospital Capital Medical University.Six patients were all male with the age from 32 to 62 years old.All patients were chronic cases diagnosing during following-up.Among which,one case was performed with the classical elephant truck technique,five cases were performed with the stented elephant truck technique.Two cases were performed the total arch replacement because of the aortic arch dissection.Results: All patients were cured and discharged from hospital,without brain and spinal cord and other nervous system complication.Acute renal failure occurred in 1 patient because of renal insufficiency before operation.After dialysis,the patient recovered.All six patients received postoperative follow up for 1 month to 26 months.1 case performed with the elephant truck technique was found endoleak at the terminal.The false lumen continued to increase by retrograde blood flow.Two years later,TSGP was performed again in the elephant truck to close the secondary entry.The other five cased performed with the stented elephant truck technique were good.The primary entry was closed completely and the false lumen was thrombosis.Conclusion: Elephant truck technique is the effective method in treating retrograde stripping following TSGP.Stented elephant truck technique is better than classical elephant truck technique.Total arch replacement would be performed at the same time,if the aortic arch dissection was combined.