Stanford B 型主动脉夹层腔内手术回顾及中期随访

 目的 总结Stanford B 型主动脉夹层的腔内手术治疗经验。方法 收集2000~2007年70例Stanford B型主动脉夹层腔内治疗病人的临床资料，通过对其回顾性研究，结合术前影像学、术中数字减影动脉造影术DSA（digital subtraction angiography）、术后门诊影像学随访资料。观察夹层病变的急性期解剖学数据，在随后的随访过程中观察有无内漏、移位和人工血管内支架塌陷等术后并发症，寻找并发症出现的一些高危因素。结果 70例患者平均有2.66个破口，第一破口平均距离左锁骨下动脉27.61mm。3例同期进行左颈总、左锁骨下动脉以及2例二期进行肠系膜上动脉、肾动脉旁路术。16例支架型人工血管一期覆盖左锁骨下动脉而未做血管旁路手术。70例患者即刻I型内漏发生率为14.3％（10/70）。无移植物错放、移位、瘤体破裂和中转手术等并发症，本组技术成功率为85.7%（60/70）。随访2周～72个月后，5例发生I型内漏，3例再次接受手术。本研究表明内漏的发生同夹层病变内膜裂口数量多、术前主动脉最大直径大以及近端破口在小弯侧有关。结论 主动脉夹层腔内修复术具有安全、可行、有效的特点。临床的开拓性工作成功突破短瘤颈、内脏动脉假腔累及、破口位置较低和入路动脉过细等解剖学限制，在保证手术安全的情况下拓宽了手术适应症。远期疗效有待进一步观察。

Review and mid-term follow-up of Stanford type B aortic dissections treated by endovascular placement of stent-grafts

Object To introduce the experience of treating Stanford type B aortic dissections by endovascular implantation of stent-graft. Methods We retrospectively study on 70 patients who have been treated form 2000 to 2007, combined with their preoperative imaging examination, DSA during the procedure and postoperative follow-up imaging data. We observe the anatomical features and the complications of stent implantation such as endoleak, migration and fracture of stent-graft during the follow-up. Try to figure out the high risk factors of the complications. Results The patients have 2.66 tears in average, and the distance between the first tear and left subclavian is 27.61mm. 3 cases underwent left common carotid artery or left subclavian artery bypass, while 2 cases underwent superior mesenteric artery (SMA) and renal artery bypass before the placement of stent-graft. 16 left subclavian arteries were covered simultaneously without bypass. 10 cases (14.3%) occurred endoleak after the procedure, but complications such as misplacement, migration, rupture or conversion to open surgery were not observed. 60 cases (85.7%) were treated technical successfully. Followed up between 2 weeks and 72 months, 5 cases are observed type I endoleak and 3 cases acceptted reintervention. This study indicates that endoleak is associated with more tear number, larger aortic diameter and lesser curvature side. Conclusions The endovascular repair is a safe, efficacy and feasible therapy to aortic dissection. The creative clinic practice breakthrough the anatomy limits such as short neck, branch artery evolved, low proximal tear and narrow profile artery. Although we have widen the indication safely, the long term results keep in follow up.