本文選題：Stanford　切入點(diǎn)：B型主動(dòng)脈夾層　出處：《鄭州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的對(duì)在我院45例Stanford B型主動(dòng)脈夾層患者進(jìn)行腔內(nèi)隔絕術(shù)(EVAR)治療的的中期療效隨訪,臨床特征及診治過(guò)程進(jìn)行回顧性分析,并對(duì)其中期隨訪結(jié)果進(jìn)行總結(jié),從而評(píng)價(jià)腔內(nèi)隔絕術(shù)治療Stanford B型主動(dòng)脈夾層的中期療效和安全性。方法收集從2009年1月至2013年12月到我院接受治療的Stanford B型主動(dòng)脈夾層腔內(nèi)治療病人的病例資料,進(jìn)行回顧性分析和總結(jié)。共45例病人,男性35例,女性10例,平均50.6±11.2歲,最大年齡79歲,最小24歲。其中,合并癥有:3例夾層患者合并有破裂出血,4例患者合并有腹腔臟器急性缺血,5例患者同時(shí)合并下肢嚴(yán)重缺血,1例為急性主動(dòng)脈的透壁性潰瘍。按疾病病程分:38例屬于急性期,7例患者屬于亞急性期。本研究通過(guò)對(duì)患者術(shù)前的資料、手術(shù)過(guò)程中的造影(digital subtraction angiography,DSA)資料以及術(shù)后門診檢查結(jié)果及電話的隨訪內(nèi)容進(jìn)行綜合分析,觀察主動(dòng)脈夾層患者發(fā)病急性期所發(fā)生的解剖學(xué)數(shù)據(jù)變化、手術(shù)經(jīng)過(guò),并在后期所進(jìn)行的隨訪中觀察患者是否發(fā)生內(nèi)漏、有無(wú)支架的移位和是否發(fā)生人工血管內(nèi)支架塌陷等影響患者生存質(zhì)量的術(shù)后并發(fā)癥,根據(jù)隨訪結(jié)果和影像學(xué)資料評(píng)估患者臨床轉(zhuǎn)歸和動(dòng)脈重塑情況。分析導(dǎo)致主動(dòng)脈夾層患者急性期發(fā)生死亡的常見(jiàn)高危因素。并在此基礎(chǔ)上對(duì)選擇進(jìn)行干預(yù)的方式及時(shí)機(jī),與此同時(shí),我們?cè)噲D對(duì)導(dǎo)致腔內(nèi)隔絕術(shù)后Stanford B型主動(dòng)脈夾層向stanford A型主動(dòng)脈夾層轉(zhuǎn)化的原因進(jìn)行探究,隨訪觀察腔內(nèi)修復(fù)術(shù)后可能發(fā)生的并發(fā)癥并尋找預(yù)防和處理的方法。結(jié)果本研究術(shù)中共植入主動(dòng)脈覆膜支架51枚(選用進(jìn)口支架43枚,選用國(guó)產(chǎn)支架8枚),其中3例置入2枚支架,2例植入三枚支架。沒(méi)有術(shù)中發(fā)生死亡或因病情需要轉(zhuǎn)為開(kāi)胸手術(shù)的患者。所有的患者隨訪時(shí)間截止到2013年12月,術(shù)后30天內(nèi)共死亡2例,失訪2例,隨訪41例。平均隨訪31.3±23.7月。隨訪過(guò)程中有7例患者發(fā)生Ⅰ型內(nèi)漏,其中有2例為內(nèi)漏量大進(jìn)行短支架(Cuff)植入治療,其余5例均表現(xiàn)為少量?jī)?nèi)漏,未行處理,在隨訪過(guò)程中2例內(nèi)漏自行消失。腔內(nèi)修復(fù)術(shù)后假腔的轉(zhuǎn)歸主要有以下的類型:近端假腔消失(14/45,31.1%)、假腔內(nèi)血栓形成機(jī)化(31/45,68.9%)、夾層的遠(yuǎn)端假腔仍有血流(27/45,60%)。結(jié)論作為治療Stanford B型主動(dòng)脈夾層的一種安全并且行之有效的治療選擇,腔內(nèi)隔絕術(shù)有令人滿意的中期治療效果,實(shí)施胸主動(dòng)脈腔內(nèi)隔絕術(shù)的最佳的時(shí)機(jī)是亞急性期,在條件滿足的情況下要盡可能的避免在急性期進(jìn)行腔內(nèi)修復(fù)術(shù),術(shù)后進(jìn)行定期隨訪對(duì)提高患者的生存質(zhì)量具有重大意義。
[Abstract]:Objective to analyze the middle term follow-up, clinical characteristics, diagnosis and treatment of 45 patients with Stanford B aortic dissection treated by endovascular exclusion, and to sum up the results of middle term follow-up. Objective to evaluate the efficacy and safety of endovascular exclusion in the treatment of Stanford B aortic dissection. Methods from January 2009 to December 2013, the data of patients with Stanford B aortic dissection treated in our hospital were collected. There were 45 patients, 35 males and 10 females, with an average age of 50.6 鹵11.2 years. The maximum age was 79 years and the youngest was 24 years old. There were 3 cases of dissection complicated with rupture and hemorrhage 4 cases with acute ischemia of abdominal viscera 5 cases with severe ischemia of lower extremity 1 case with transmural ulcer of acute aorta. According to the course of disease 38 cases were classified as acute aortic ulcer. In the acute phase, 7 patients belong to subacute stage. The anatomic data of patients with aortic dissection during the acute stage of aortic dissection were observed by analyzing the data of digital subtraction angiography during operation, the results of outpatient examination and telephone follow-up. The postoperative complications such as internal leakage, stent displacement and stent collapse in the later period of follow-up were observed, which affected the quality of life of the patients. According to the follow-up results and imaging data, the clinical outcome and arterial remodeling were evaluated. The common risk factors leading to death in acute stage of aortic dissection were analyzed. At the same time, we try to explore the causes of the transformation of Stanford B aortic dissection to stanford A aortic dissection after endovascular exclusion. The possible complications after endovascular repair were observed and the methods of prevention and treatment were explored. Results 51 aortic stents (43 imported stents) were implanted in this study. 8 domestic stents were selected, of which 3 cases were implanted with 2 stents and 2 cases were implanted with 3 stents. There were no patients who died during operation or had to undergo thoracotomy because of their condition. All patients were followed up until December 2013. A total of 2 cases died, 2 cases lost their visits and 41 cases were followed-up within 30 days after operation. The average follow-up was 31.3 鹵23.7 months. During the follow-up, 7 cases had type 鈪，

本文編號(hào)：1645445