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StanfordB型主动脉夹层腔内治疗临床分析
引用本文:张成超,吴继东,刘宏,赵京,李新宇,张宇,刘苏建. StanfordB型主动脉夹层腔内治疗临床分析[J]. 中国航天工业医药, 2013, 0(8): 21-22
作者姓名:张成超  吴继东  刘宏  赵京  李新宇  张宇  刘苏建
作者单位:北京航天总医院血管外科,100076
摘    要:目的分析StanfordB型主动脉夹层腔内修复的治疗经验。方法总结2012年7月~2013年2月经腔内治疗7例StanfordB型主动脉夹层患者资料,所有患者均在计算机体层血管造影(Computedtomographyangiography,CTA)条件下确定诊断,在数字减影血管造影(Digitalsubtractionangiography,DSA)和全身麻醉条件下行腔内隔绝术。按照术后1个月、6个月、12个月的随访计划,观察瘤体形态学改变、治疗效果及并发症的发生情况。结果腔内技术成功率100%(7,7),临床成功率100%(7,7),术后住院期间无死亡患者,无左锁骨下动脉完全封闭,部分封闭2例,左锁骨下动脉烟囱支架2例,夹层累及腹腔干1例,肠系膜上动脉1例,累及一侧肾动脉2例,腹主动脉段存在远端破口2例,髂总动脉及髂外动脉存在远端破口1例。所有患者术后均未出现脑供血不足的临床表现,无截瘫情况发生,经过1个月、6个月及12个月的随访均正常存活,无新破口出现。结论StanfordB型主动脉夹层腔内治疗是一种有效方法,在血压控制平稳条件下,应尽快完成腔内修复治疗,对于夹层累及多个脏器动脉情况,应观察脏器血液灌注流速及流量,如有脏器严重缺血情况出现,应及时放置支架缓解血供,对于多个远端破口病例,应根据具体情况,在避免并发症的基础上尽早完成破口的封闭,并加强随访,观察病变处的动态变化。

关 键 词:主动脉夹层  腔内修复  支架

Analysis of endovascular repair for Stanford B aortic dissection
Affiliation:Zhang Chengchao,Wu Jidong,Liu Hong,et al. Beijing Aerospace General Hospital ,Beijing 100076
Abstract:Objective To investigate and summarize the experience of treating Stanford B aortic dissection by endovas- eular implantation of stent-grafts. Methods Computed tomography angiography was used to diagnose and aquire 7 eases with anatomical material of dissection. Stent-grafts of all patients were implanted on the condition of DSA and general anesthesia. Followed-up for 1 month,6 months and 12 months,and observed the complications, therapeutic efficacy and morphological changes of the aneurysms. Results The technical and clinical success rate were 100%. No deaths happened. Left subclavian artery (LSA) were covered partially in 2 patients and the funnels were then implanted to ensure the blood volume of left upper limb. Celiac trunk of 1 case, superior mesenteric artery of 1 case and unilateral renal artery of 2 cases were involved. 2 eases had distant tears of abdominal aorta. Common iliac artery and external iliac artery oceured in 1 case. There were no obvious cerebrolvascular insufficiency and paraplegia occurred. No deaths occurred after the follow-up of 1 month,6 months and 12 months. Conclusion Endovascular therapy was the effective measure of treating Stanford B aortic dissection. It should be done as soon as possible after stable blood pressure, implant stent-grafts if the splanchnie artery was involved by the dissection. For those patients that had other tears exited, endovascular implantation of stent-grafts should be done quickly according to spe- cific condition. Following-up should be strengthened to ensure the security of patients.
Keywords:Aortic dissection Endovascular repair Grafts
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