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胸主动脉腔内修复术治疗Stanford B型主动脉夹层
引用本文:王湘,李刚,杨建安.胸主动脉腔内修复术治疗Stanford B型主动脉夹层[J].岭南心血管病杂志,2014(4):480-483.
作者姓名:王湘  李刚  杨建安
作者单位:深圳市孙逸仙心血管医院外科,广东深圳518020
摘    要:目的 总结胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)治疗Stanford B型主动脉夹层的临床经验.方法 回顾性分析134例Stanford B型主动脉夹层患者的临床资料,分析并发症发生的原因及随访近、远期效果.结果 术前死亡4例,未手术1例,施行TEVAR 129例,手术操作均成功,部分封堵左锁骨下动脉27例(20.9%),完全封闭左锁骨下动脉12例(9.3%);Ⅰ型内漏13例(10.1%),夹层逆剥为Stanford A型1例,低氧血症23例(17.8%),肾功能衰竭需血液滤过9例(7.1%),术后精神症状37例(28.7%),脑梗死3例.随访2个月~5年,随访110例,随访率85.7%,1例术后1年和1.5年出现支架远端夹层,两次手术植入覆膜支架,部分封闭了腹腔干动脉,1例术后2个月时因肠梗阻在外院行手术治疗,1例术后4年时支架远端发生夹层破裂死亡,1例术后3个月突然死亡.Ⅰ型内漏消失11例,持续存在2例.结论 急诊TEVAR治疗Stanford B型主动脉夹层安全、可靠,近期效果良好,加强并发症的防治,可进一步改善临床效果.

关 键 词:胸主动脉腔内修复术  Stanford  B型主动脉夹层  血管腔内支架

Outcomes and experience of thoracic endovascular aortic repair for Stanford type B aortic dissection
WANG Xiang,LI Gang,YANG Jian-an.Outcomes and experience of thoracic endovascular aortic repair for Stanford type B aortic dissection[J].South China Journal of Cardiovascular Diseases,2014(4):480-483.
Authors:WANG Xiang  LI Gang  YANG Jian-an
Institution:(Department of Cardiovascular Surgery, Sun Yat-sen Cardiovascular Hospital, Shenzhen, Guangdong 518020, China)
Abstract:Objectives To summarize the clinical experience of thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissention.Methods Clinical data of 134 patients with Stanford type B aortic dissention were reviewed retrospectively,in order to analyze causes for complications,short-term and long-term effects during follow-up.Results Preoperative death occurred in 4 patients and 1 patient died without operation.There were 129 patients received TEVAR and cured.Left subclavian artery was partially covered in 27 patients (20.9%),completely covered in 12 patients (9.3%).And there were type Ⅰ endoleaks in 13 patients (10.1%),aortic dissection reverse peel to type A aortic dissection in 1 patient,hypoxemia in 23 patients (17.8%),renal failure requiring hemodialysis treatment in 9 patients (7.1%),postoperative psychiatric symptoms in 37 patients (28.7%) and cerebral infarction in 3 patients.A follow-up ranged from 2 months to 5 years was conducted in 110 patients with a follow-up rate of 85.7%.Dissection distal to the stent was found in one case 1 and 1.5 years after surgery,who was performed operations to implant covered stents twice and partial occlusion for celiac artery.One patient received surgery in another hospital because of intestinal obstruction 2 months after TEVAR.One patient died from ruptured dissection at far-end of the stent 4 years after TEVAR.One patient died suddenly 3 months after surgery.Type Ⅰ endoleaks disappeared in 11 patients but consistently appeared in 2 patients.Conclusions Emergency TEVAR for Stanford type B aortic dissention is safe and its short-term outcomes are good.To strengthen prevention of complications can further improve its clinical effect.
Keywords:thoracic endovascular aortic repair  Stanford type B aortic dissention  endovascular stent graft
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