目的:探討帶膜支架腔內(nèi)隔絕術(shù)治療B型主動(dòng)脈夾層的技術(shù)方法及療效。方法:對(duì)近年我院收治的40例主動(dòng)脈夾層進(jìn)行分析。40例患者均行股動(dòng)脈穿刺插管至升主動(dòng)脈造影,了解主動(dòng)脈真假腔、夾層裂口及其與重要血管分支位置關(guān)系。切開右或左側(cè)股動(dòng)脈置入覆膜血管內(nèi)支架,封堵原發(fā)破口,置入支架后重復(fù)造影檢查。觀察真假腔血流變化、主動(dòng)脈分支供血的情況。結(jié)果:40例患者支架置入定位準(zhǔn)確,術(shù)后即刻造影顯示真腔血流恢復(fù)正常。手術(shù)成功率100%,無術(shù)中轉(zhuǎn)開胸手術(shù),無截癱及瘤體破裂等嚴(yán)重并發(fā)癥,無圍手術(shù)期死亡。所有患者術(shù)后3~6個(gè)月復(fù)查增強(qiáng)CT,假腔不再顯影,支架通暢,無扭曲、移位。結(jié)論:帶膜支架腔內(nèi)隔絕術(shù)治療B型主動(dòng)脈夾層具有創(chuàng)傷小,術(shù)后恢復(fù)快,手術(shù)死亡率低,手術(shù)成功率高的優(yōu)點(diǎn),但遠(yuǎn)期效果有待進(jìn)一步觀察。
引用本文: 張仁宇,楊建,楊帆,譚今. 帶膜支架腔內(nèi)隔絕術(shù)治療B型主動(dòng)脈夾層40例分析. 華西醫(yī)學(xué), 2009, 24(1): 50-52. doi: 復(fù)制
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- 1. NienaberCA,F(xiàn)attoriR,Lund G,et al. Nonsurgical reconstruction of thoracic dissection by stentgraftplacement[J].N Engl JMed,1999,340(20):1539-1545..
- 2. 邸龍輝,荊全民.Stanford B型主動(dòng)脈夾層治療新進(jìn)展[J].中國(guó)實(shí)用內(nèi)科雜志,2007,27(22):1796-1798.
- 3. Svensson LG.New and future approaches for spinal cord protection[J].Semin Thorac Cardiovasc Surg,1997,9(3):206-221..
- 4. 景在平.主動(dòng)脈夾層的診斷和腔內(nèi)隔絕術(shù)應(yīng)用指南(初稿)[J].中國(guó)實(shí)用外科雜志,2004,24(3):129-133..
- 5. Wang ZG,LiC.Singlebranch endograft for treating stanford type B dissectionswith entry tears in proximity to the left subclavian artery[J].J Endovasc Ther,2005,12 (5):588-593..
- 6. 劉正軍,陳爾瑜.臨床解剖學(xué)叢書胸部和脊柱分冊(cè)[M].北京:人民衛(wèi)生出版社,1991:380-382.
- 7. 景在平,包俊敏,周穎奇,等.腔內(nèi)隔絕術(shù)治療主動(dòng)脈夾層動(dòng)脈瘤[J].第二軍醫(yī)大學(xué)學(xué)報(bào),1999,20(11):828-830..
- 8. Schurink GW,Aarts NJ,vanBockel JH.Endoleak after stentgraft treatment of abdominal aortic aneurysm:a metaanalysis of clinical studies[J].Br J Surg,1999,86:581-587..
- 9. 汪忠鎬,陳學(xué)明,余軍,等.支架型人工血管治療主動(dòng)脈夾層動(dòng)脈瘤[J].中國(guó)普通外科雜志,1999,8:403-405..
- 10. 張喆,楊碧波.覆膜血管支架治療DebakeyⅢ型主動(dòng)脈夾層[J].中國(guó)微創(chuàng)外科雜志,2008,8(1):70-71..