【摘要】：目的探討胸主動脈腔內(nèi)修復(fù)術(shù)(TEVAR)治療Stanford B型主動脈夾層(AD)方法與療效。方法回顧性分析2010年1月至2016年4月采用TEVAR治療的85例Stanford B型AD患者臨床資料。85例患者均常規(guī)行左肱動脈穿刺,右側(cè)股動脈直切口,升主動脈DSA造影明確AD破口位置、真假腔及與重要器官血管開口位置關(guān)系;置入覆膜血管內(nèi)支架,封堵原發(fā)破口,升主動脈造影復(fù)查觀察近端破口封閉情況及主動脈弓部分支血管、真假腔血流變化情況。結(jié)果 84例患者TEVAR手術(shù)成功,成功率100%;1例術(shù)前麻醉過程中突發(fā)AD破裂死亡。9例部分覆蓋左鎖骨下動脈,1例左鎖骨下動脈"煙囪"支架完全封閉左頸總動脈和左鎖骨下動脈,2例行無名動脈至左頸總動脈和左鎖骨下動脈轉(zhuǎn)流。Ⅰ型內(nèi)漏2例,無住院期間死亡。術(shù)后隨訪3個月至3年,患者均存活,遠端再發(fā)新破口2例。結(jié)論 TEVAR術(shù)治療Stanford B型AD安全有效,嚴格把握手術(shù)指征、術(shù)中精細操作及加強術(shù)后院外管理是手術(shù)成功、提高遠期生存率關(guān)鍵。
[Abstract]:Objective to evaluate the efficacy of endovascular thoracic aortic repair (TEVAR) in the treatment of Stanford type B aortic dissection (Stanford B). Methods the clinical data of 85 patients with Stanford type B AD treated with TEVAR from January 2010 to April 2016 were analyzed retrospectively. 85 cases of AD patients were treated with left brachial artery puncture, right femoral artery direct incision, ascending aortic DSA angiography to determine the location of AD breakage. The relationship between the true and false lumen and the position of the vascular opening in the important organs, the placement of the covered stent, the closure of the primary break, the reexamination of ascending aortography to observe the closure of the proximal break and the changes of the blood flow in the aortic arch and the true and false lumen. Results 84 patients underwent TEVAR operation successfully. Success rate 100. 1 patient died of AD rupture during anaesthesia before operation. 9 patients died partially covered with left subclavian artery. 1 patient with left subclavian artery "chimney" stents completely closed left common carotid artery and left subclavian artery. 2 cases with left unnamed artery to left subclavian artery. Common carotid artery and left subclavian artery bypass. Type 鈪，

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