临床论著覆膜血管支架治疗DebakeyⅢ型主动脉夹层张 喆 杨碧波(北京大学第三医院心脏外科,北京 100083) 【摘要】 目的 探讨覆膜血管支架治疗DebakeyⅢ型主动脉夹层的疗效。
方法 2001年6月～2006年7月,经CT增强扫描确诊DebakeyⅢ型主动脉夹层31例。
切开右或左侧股动脉置入覆膜血管内支架,封堵原发破口,置入后重复造影检查。
结果 支架置入全部成功,术后即可造影27例无内漏,4例轻度内漏。
术后早期1例出现左上肢缺血,1例截瘫,其余患者无支架移位与远端脏器缺血。
术后半年复查CT增强扫描,31例均示支架段内假腔消失,血栓形成。
术后半年4例轻度内漏均好转;1例术后4年出现支架近端严重内漏,行开胸手术治疗。
结论 覆膜支架腔内修复术是治疗DebakeyⅢ型主动脉夹层的有效方法,但远期效果有待进一步观察。
【关键词】 主动脉夹层; 覆膜支架 中图分类号:R654.3 文献标识:A 文章编号:1009-6604(2008)01-0070-02En dova scu l a r Sten t2Gr af t P l a ce m en t for the Tr ea tm en t of Deba keyⅢType Aor t i c D issect i on s Zha ng Zhe,Ya ng B ibo.D epa rt ment o f Cardio surgery,Peking U ni versity Third Hospital,Beiji ng100083,China【Abstra c t】 O b ject i ve T o eva l uate the efficacy of endovascular stent2graf t place m ent for the trea t ment of DebakeyⅢty pe aortic diss ec ti on. M e thod s From June2001t o July2006,31pa tients w ith DebakeyⅢty pe aortic dissecti on we re diagnosed by contrast2enhanced CT scan.Va s cula r access was obta i ned through the rig h t or left femoral a rtery after arte ri ot o m y and st ent2graft was deployed int o the true lu men t o occ l ude the pri ma ry entry tear.I mm edia t e ao rtographywas perf o r med after the p r ocedure and the f o ll ow2 up da ta of CT scan we re eva luated. R esu lts Stent2graft depl oy m ent wa s s ucce ssfully pe rfor m ed in all the patients.I m mediate aortography afte r the p r ocedure s howed no leakage in27pa tients and m inor l eakage in4.Aft e r the ope ra ti on,one pa tient sho wed pa raplegia,and one deve l oped left a r m ischem ia.No stentmove m ent or organ is chem ia wa s found a t the early post opera tive stage in the ot her pa tients.Si x months afte r the operati on,in all the31pa tients,contrast2enhanced CT s can sho wed the d isappea rance of the fa lse lu men and thro m b osis a t the level of the stent;and t he m inor leakage of was i mprov ed in the4patients.Four years aft e r t he operati on, one patient devel oped severe internal leakage a t the app r oxi m al end of the stent,and was treated by t horacot o m y. C onclu si on s Endovascular stent2graft placement is effective for the treat ment of DebakeyⅢt ype aortic dissection.Ho weve r,furthe r studies a re needed t o ev a luate its long2te r m outcome s.【Key W or ds】 Aortic dissecti on; Endova scula r stent2graft DebakeyⅢ型主动脉夹层为累计左锁骨下动脉动脉开口以远的降主动脉夹层,急性期病死率约为30%,传统开胸手术治疗因创伤大,并发症较多,以往多倾向于保守治疗[1]。
