急性Stanford B型主动脉夹层并胸腔积血腔内血管外科治疗（附20例临床报告）

目的探讨急性Stanford B型主动脉夹层合并胸腔积血的腔内血管外科治疗的早、中期疗效。方法20例急性Stanford B型主动脉夹层合并胸腔积血患者，均行支架形人工血管植入腔内修复术。术后3、6、12个月及每年一次复诊。结果本组共植入支架20个，支架释放后即刻造影显示第一破口封堵率为100％。13例术前胸腔积血进行性减少的患者在术后胸腔积血完全吸收。7例术前胸腔积血进行性增多的患者，术后2例胸腔积血得以控制并逐渐吸收减少；另5例患者于术后第1～3d胸腔积血仍呈进行性增多，于术后第3～6d胸腔积血得以控制，遂于术后第3～12d进行多次控制性胸腔穿刺抽吸积血，呼吸功能均能维持。元围手术期死亡。19例平均随访16（3～57）个月，支架覆盖段胸主动脉情况稳定，术后5例胸腔积血进行性增多的患者发生胸部并发症。结论急性Stanford B型主动脉夹层合并胸腔积血患者在进行腔内血管外科治疗后近期、中期内观察疗效确切，远期疗效有待于进一步观察。

Endovascular Therapy of Acute Stanford Type B Aortic Dissection Combined with Hemothorax (A Report of 20 Cases)

Objective To evaluate the early and midterm results of endovascular therapy for acute Stanford type B aortic dissection complicated with hemothorax. Methods 20 patients of acute Stanford type B aortic dissection with hemothorax treated by endovascular therapy were reviewed retrospectively. Fellow-up was performed at 3,6,12 months and yearly thereafter. Results Total 20 stent-grafts were implanted. The blockade rate of the first crevasse was achieved 100% after the stent-graft implantation. 13 cases of progressive decreasing hemothorax were recovered after stent-graft placement. In the 7 cases with progressive increasing hemothorax, 2 were controlled after the operation, but 5 were progressively increased within 3 days and then controlled in 3 to 6 days after operation. Respiratory functions were maintained due to multiple controlled thoracentesis aspirations performed in the 5 cases of progressive increasing hemothorax in 3 to 12 days after the stent- graft implantation. There was no death case during perioperative period. 19 cases were followed up for 3 to 57 months. The outcomes showed aortic stabilization was achieved in the stented segments. Thorax complications were found in the 5 cases of progressive increasing hemothorax after surgery. Conclusions The short- and medium term efficacy of endovascular therapy are safe and effective for acute Stanford type B aortic dissection with hemothorax. Moreover, prostecdtive efficacy would be further observed.