摘要
目的 探讨StanfordB型夹层动脉瘤的微创腔内隔绝术治疗的价值及应用经验。方法 采用进口器具治疗 2 6例StanfordB型夹层动脉瘤 ,术前精确评估 ,正确选择移植物 ,DSA监控下将移植物导入裂口位置 ,使假腔与真腔隔绝。结果 2 6例中 ,移植物置入全部成功 ,无术中死亡或中转开胸手术 ;术中内漏 3例 ,术后 3天左上肢动脉血栓形成 1例 ,胸骨后疼痛 1例 ,腹股沟切口延迟愈合 2例 ,术后 6天心梗猝死 1例。中期结果示假腔内血栓形成率为 89 5 %。结论 度过急性期 3周的StanfordB型夹层动脉瘤为腔内隔绝术的手术适应证 ,螺旋CT为术前评估的最佳方法 ,术中应准确定位左锁骨下动脉开口 ,远端裂口宜分期行腔内隔绝术。腔内隔绝术微创、安全、方法简单、疗效确切 ,病人术后痛苦小 ,恢复快 ,在StanfordB型夹层动脉瘤有较大应用价值。
Objective To evaluate the method of endovascular graft exclusion for Stanford type B dissecting thoratic aortic aneurysms.Methods 26 patients with Stanford type B dissecting thoratic aortic aneurysms accepted endovascular graft exclusion by the application of imported stent-grafts.The aneurysms were accurately measured,and the grafts were carefully selected.Monitored by DSA,the grafts were carried to the area near the fissure.Thus,the fissure was sealed,and the false lumen was excluded from the blood flow.Results All the deploying procedures were successful,and there was no death or conversion to open surgery during the operation.Three endoleaks occurred.One occurred embolization in left upper limb three days after the procedure.Delayed healing of the incision occurred in two cases.There was one patient dead of heart infarction 6 days later.The mid-term results show that the thrombosis ratio of the false lumen is 89 5%.Conclusion Indications of EVGE are that:three weeks after acute dissection formation in the patients with Stanford type B dissecting thoratic aortic aneurysms.The best preoperative imaging evaluating method is spiral CT.In operation,the orifice of left subclavicular artery should be marked precisely.The distal fissure might be sealed in a later period.The EVGE is a mini-traumatic,safe and simple therapy,and of certain curative effect.It is of great value in the treatment of Stanford type B dissecting thoratic aortic aneurysms.The patients would suffer much less pain and enjoy quick recovery after the operation.
出处
《中国实用外科杂志》
CSCD
北大核心
2000年第6期340-343,I000,共4页
Chinese Journal of Practical Surgery
基金
军队杰出人才基金 !( 98J0 0 5 )
上海卫生系统百人计划基金 ! 97BR0 47
第二军医大学长海医院学科攀登计划基金
