腔内隔绝术治疗DeBakeyⅢ型夹层动脉瘤56例临床分析

目的探讨DeBakeyⅢ型主动脉夹层动脉瘤腔内治疗的手术指征、术前评估方法、手术操作技巧、并发症防治原则。方法对56例行DeBakeyⅢ型主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析。术前采用CT血管造影（CTA）或磁共振血管造影（MRA）对主动脉夹层动脉瘤进行评估,术中在数字减影血管造影（DSA）监视下经股动脉或髂动脉将移植物导入胸主动脉封闭夹层裂口。结果术中移植物成功释放56例,46例仅使用1支移植物封闭夹层近端裂口,6例使用2支移植物封闭夹层近端裂口,4例同时封闭夹层近端及远端裂口,无围手术期死亡病例,其余病例术后无心、肺、肾功能衰竭及截瘫等严重并发症。随访3个月～3年,2例分别于术后6、11个月再发StanfordA型胸主动脉夹层动脉瘤,再次行腔内治疗,其余患者未出现与夹层动脉瘤及手术相关的并发症。结论腔内隔绝术治疗DeBakeyⅢ型型主动脉夹层动脉瘤是一种创伤小、恢复快的新方法,短期的随访结果表明该技术安全有效。内漏是该方法的主要并发症,远期疗效有待继续观查。

Clinical analysis of 56 cases in DeBakey type Ⅲ aortic dissection aneurysm with endovasculr graft exclusion

Objective To study the surgical indications, preoperative evaluation methods, surgical techniques, prevention of complications principle and clinical prospects in DeBakey type IIIaortic dissection aneurysm in which endovascular graft exclusion was used. Methods Retrospective analysis of the clinical data about 56 cases in DeBakey type Ⅲ-aortic dissection aneurysm, CTA or MRA for preoperative evaluation, in the course of surgery, the grafts were inserted thoracic aortic from femoral artery or iliac artery to close the aortic dissection hole, the DSA was used for surveillance at the same time. Results In the course of surgery, there were 56 cases released the grafts successfully, there were 46 cases with only one graft to close the proximal aortic dissection hole, 6 cases with two grafts,4 cases for proximal and distal aortic dissection hole, no patients with perioperative death, heart failure,lung failure,renal failure, paraplegia and other serious complications. Follow-up stndy was 3 months to 3 years,2 cases recurreneed Stanford type A-aortic dissection aneurysm after surgery 6 and l lmonths in which endovascular treatment were used again. There were no postoperative complications related with aortic dissection aneurysm in the other cases. Conclusion Endovascular graft exclusion is known as a new method in treatment for patients with Stanford type B- aortic dissection aneurysm by short-term follow up, it also has a less trauma , fast rehabilitation, effective and safe method , internal leakage is major complication, long-term observation is necessary.