急性期Standford B型主动脉夹层腔内修复术后早、中期随访结果

目的 评价急性期StanfordB型胸主动脉夹层(TAD)腔内修复术后早、中期手术效果.方法 2009年11月至2012年6月完成80例急性期Stanford B型胸主动脉夹层腔内修复术,手术在发病72 h内完成.手术前行胸腹主动脉夹层强化CT检查,在DSA手术室全麻下切开股动脉进行支架置入术,出院前进行CTA检查,手术后半年至一年内复查CTA.结果 14例患者手术后失去随访.5例术后造影提示有Ⅰ型内漏,4例1年内复查消失或造影剂溢出量明显减少,1例手术后仍有明显Ⅰ型内漏,1年后接受再次支架手术成功.其余支架安装后造影显示破口封闭,无内漏.住院期间死亡2例,1例为高龄患者降主动脉破裂,1例为夹层逆行撕裂至升主动脉后破裂.住院期间发生严重低氧血症8例,急性肾功能不全6例,均经治疗后恢复.结论 急性期Stanford B型胸主动脉夹层进行腔内修复术,术后早期并发症发生率高,中期效果理想.

The early and mid-term follow-up of endovascular aortic repair for acute aortic dissection of Standford type B dissection

Objective To research the early and mid-term follow-up results of thoracic endovascular aortic repair （TEVAR）for acute Stanford type B dissection. Methods From November 2009 to July 2012, 80 patients with Stanford type B dissection within 72 hours of symptom onset accepted TEVAR. Patients were taken to CTA examination before the operation. The stent was implanted through femoral artery under general anesthesic in DSA room. The patients took CTA examination when discharge and 6 months later. Results 14 patients lost to follow-up. Five cases existed with type I endoleak, in 4 cases endoleak disappeared six months later one had received another stent one year later and the endoleak disappeared. Others were succeeded with the operation without endoleak or shifting. 2 case died in hospital one old man died of descending aortic rupture, another one died of retrograde ascending aortic dissection and rupture. 8 eases were complicated with severe hypoxemia and 6 cases with acute kidney failure during the perioperative period and recovered after treatment. Conclusion The earlyterm incidence of complications after TEVAR in patients with acute type B dissection are high and the mid-term results are good.