胸主动脉腔内修复术治疗Stanford B型主动脉夹层

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.

Outcomes and experience of thoracic endovascular aortic repair for Stanford type B aortic dissection

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.