摘要
背景:常规的覆膜支架治疗DeBaKeyⅢ型主动脉夹层手术繁杂,并发症发生率较高,其操作技术有增加夹层破口破裂的风险。目的:应用改良的大动脉覆膜支架和创新的介入治疗方法腔内修复治疗DeBaKeyⅢ型主动脉夹层,观察其疗效和安全性。设计、时间及地点:回顾性病例分析,病例来自2006-10/2009-03赣南医学院第一附属医院心血管内科。对象:选择赣南医学院第一附属医院心血管内科收治的DeBaKeyⅢ型主动脉夹层患者30例,均为男性,年龄43～70(53.5±12.8)岁。发病时间为5～45d不等。方法:全部病例选用细钢丝捆绑的覆膜支架和创新输送及释放支架的方法,对降主动脉破口与左锁骨下动脉距离<10mm的DeBaKeyⅢ型主动脉夹层,可选用分支型大动脉覆膜支架。主要观察指标:支架置入成功后复行主动脉造影,了解覆膜支架位置,形态,夹层破口封闭和内漏以及主动脉弓分支血管通畅情况;观察术后并发症情况。术后行磁共振检查随访支架情况,有无瘤体破裂、内漏及支架移位等并发症。结果:30例共置入33枚细钢丝捆绑覆膜支架,其中4例因降主动脉破口与左锁骨下动脉距离<10mm而置入分支型支架;5例支架置入后出现明显内漏,3例予球囊扩张,2例再置入1枚支架后内漏消失;1例患者置入后3个月支架远端出现新的破裂口而再置入1枚支架成功,3例出现右下肢麻木症状,1例出现右下肢间歇性跛行。所有患者置入后3～32个月随访,行磁共振检查示假腔缩小并见腔内血栓形成,真腔增大,无瘤体破裂、内漏及支架移位等并发症。结论:采用细钢丝捆绑大动脉覆膜支架、创新输送和释放支架方法治疗DeBaKeyⅢ型主动脉夹层,具有技术操作容易、可靠、创伤小、术后恢复快、成功率高、并发症少等优点,尤其适用于高危患者。
BACKGROUND： Conventional endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection is complicated and the complication rates are relatively high. Moreover, their operating techniques have increased the risk of rupture of laminated break. OBJECTIVE： To evaluate the efficacy and safety of improved endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection by the innovative methods of interventional therapy. DESIGN, TIME AND SETTING： A retrospective case analysis. Cases were selected from Department of Cardiology, Affiliated Hospital of Gannan Medical College between October 2006 and March 2009. PARTICIPANTS： A total of 30 male patients with Debakey Ⅲ type aortic dissection were selected from Department of Cardiology, Affiliated Hospital of Gannan Medical College, aged 43-70（53.5±12.8） years. The time of onset was 5-45 days. METHODS： All patients underwent improved endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection by the innovative methods of interventional therapy. Fine wire bundled endovascular stent-graft were implanted by the innovative transmission and delivery methods in all patients, of which branch stent were implanted when the distance from the break of descending aorta to left subclavian artery was less than 10 mm. MAIN OUTCOME MEASURES： After the success of operation, aortic angiography was performed to detect stent-graft position, shape, break closure, internal leakage, and patency of the aortic arch branches. The situation of post-operative complications were observed. All cases were followed up by MRI to understand the complications such as aneurysm rupture, internal leakage and stent migration. RESULTS： A total of 33 fine wire bundled endovascular stent-graft were successfully implanted in 30 patients, including 4 branch stents. After the operation, 5 patients were verified endoleak, 3 of them were resolved by repeated stent distension and 2 were treated by implantation of another stent. Three months after the operation, 1 pat
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第48期9483-9486,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
