主动脉疾病专题研究(Monographic Study of Aortic Diseases)

腔内治疗破口位于升主动脉的Stanford A 型主动脉夹层

Published at: 2015年第24卷第12期

张喆 1 , 陈学明 1 , 李晨宇 1 , 冯海 1 , 于宏志 1 , 朱仁明 1
1 首都医科大学附属北京友谊医院 血管外科,北京 100050
通讯作者 学明 陈 Email: chenxueming04@sohu.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.12.002
基金:

摘要

目的:总结腔内方法治疗破口位于升主动脉的Stanford A 型主动脉夹层的经验。 方法:回顾性分析6 例破口位于升主动脉的Stanford A 型主动脉夹层行升主动脉覆膜支架植入术或联 合弓部分支重建术的患者临床资料。 结果:所有患者全部成功施行手术,4 例行升主动脉覆膜支架植入术,2 例先行颈- 颈动脉人工血管转 流后再行升主动脉覆膜支架植入术。术后并发急性脑梗塞1 例,急性心功能衰竭1 例,呼吸功能不全2 例。 1 例因夹层破裂出血术后1 d 死亡,其余患者均安全出院。随访时间3~48 个月,随访期间2 例出现 I 型内漏,均未再接受手术继续随访。 结论:对于一些不能耐受传统手术的高危患者,腔内治疗A 型夹层以其微创的优势,可作为传统手术 的替代方法挽救患者生命。


Endovascular treatment for Stanford type A aortic dissection with entrance tear in ascending aorta

Abstract

Objective: To review the experience of endovascular treatment for Stanford type A aortic dissection with the entrance tear locating at the ascending aorta. Methods: The clinical data of 6 patients with Stanford type A aortic dissection an entrance tear at the ascending aorta who underwent ascending aortic stent-graft implantation or that combined with arch branch revascularization were retrospectively analyzed. Results: Procedures were successfully performed in all patients, of whom 4 cases underwent ascending aortic stent-graft implantation, and the other 2 cases underwent prosthetic carotid-carotid crossover bypass grafting prior to ascending aortic stent-graft implantation. After operation, acute cerebral infarction occurred in one case, acute myocardial infarction occurred in one case, and respiratory insufficiency occurred in two cases. One case died on postoperative day 1 due to hemorrhage from rupture of the aortic dissection, and the remaining cases were safely discharged. During 3- to 48-month follow-up, 2 cases developed type I endoleak, and were continuously followedup without a second operation. Conclusion: For some high-risk patients who cannot tolerate traditional surgery, endovascular procedures by virtue of their minimal invasiveness can be used as an alternative approach to save their lives.


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引用

引用本文: 喆 张, 学明 陈, 晨宇 李, 海 冯, 宏志 于, 仁明 朱. 腔内治疗破口位于升主动脉的Stanford A 型主动脉夹层[J]. 中国普通外科杂志, 2015, 24(12): 1649-1653.
Cite this article as: ZHANG Zhe, CHEN Xueming, LI Chenyu, FENG Hai, YU Hongzhi, ZHU Renming . Endovascular treatment for Stanford type A aortic dissection with entrance tear in ascending aorta[J]. Chin J Gen Surg, 2015, 24(12): 1649-1653.