腔内修复术治疗Stanford B型主动脉夹层

目的研究腔内修复术治疗Stanford B型主动脉夹层.方法对176例Stanford B型主动脉夹层患者行腔内修复术,术前行CTA影像学检查,判断主动脉夹层裂口位置与数量及胸主动脉瘤范围、左锁骨下动脉开口左侧胸主动脉直径、近端裂口至左锁骨下动脉开口的距离、真腔直径以及腹主动脉主要分支血管的血供来源,选支架规格及输送路径,然后在全麻下行右股动脉切开,透视引导下置入支架释放系统,定位准确后释放覆膜支架,完成腔内修复术.结果 176例患者腔内修复术均获得成功,出现内漏9例.随访1～24个月,复查CTA后内漏完全消失,未行再次介入或手术治疗.全部病人术后无截瘫发生,胸背部疼痛症状消失.结论与传统手术相比,腔内修复术治疗Stanford B型主动脉夹层是一种创伤小、严重并发症少、住院时间短、疗效确切的方法,但远期效果仍有待进一步观察.

Endovascular Aortic Repairing Treatment for Stanford Type B Thoracic Aortic Dissection

Objective To study endovascular aortic repairing treatment for the Stanford type B thoracic aortic dissection.Methods 176 patients underwent EVAR.Preoperative computed tomography angiography（CTA）was performed to confirm the location and number of the dissecting tears and range.The blood flow in the main branch from the abdominal aorta was estimated.The suitable graft was selected and delivery route was decided.After general anaesthesia,the right femoral artery（FA）was cut open.The delivery system was inserted to the aorta though the opening of FA and graft was released after accurate posisioning under the guidance of fluoroscopy.Results The endovascular aortic repairing treatment was successful in all 176 patients.Type I internal hemorrhage was found in 9 patients.The patients were followed up for one to twenty four months,and internal hemorrhage disappeared after CTA recheck,the patients were given intervention or operation treatment again.No paraplegia occurred in patients after treatment,and the back pain was released in all patients.Conclusions Compared with traditional operation,EVAR may be a mini-invasive alternative treatment with less complications,shorter hospital stay,and satisfactory efficacy.However,the long-term efficacy needs further study.