本文選題：Stanford　切入點：B型主動脈夾層　出處：《鄭州大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的對在我院45例Stanford B型主動脈夾層患者進行腔內隔絕術(EVAR)治療的的中期療效隨訪,臨床特征及診治過程進行回顧性分析,并對其中期隨訪結果進行總結,從而評價腔內隔絕術治療Stanford B型主動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型主動脈夾層腔內治療病人的病例資料,進行回顧性分析和總結。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例患者同時合并下肢嚴重缺血,1例為急性主動脈的透壁性潰瘍。按疾病病程分:38例屬于急性期,7例患者屬于亞急性期。本研究通過對患者術前的資料、手術過程中的造影(digital subtraction angiography,DSA)資料以及術后門診檢查結果及電話的隨訪內容進行綜合分析,觀察主動脈夾層患者發(fā)病急性期所發(fā)生的解剖學數(shù)據(jù)變化、手術經(jīng)過,并在后期所進行的隨訪中觀察患者是否發(fā)生內漏、有無支架的移位和是否發(fā)生人工血管內支架塌陷等影響患者生存質量的術后并發(fā)癥,根據(jù)隨訪結果和影像學資料評估患者臨床轉歸和動脈重塑情況。分析導致主動脈夾層患者急性期發(fā)生死亡的常見高危因素。并在此基礎上對選擇進行干預的方式及時機,與此同時,我們試圖對導致腔內隔絕術后Stanford B型主動脈夾層向stanford A型主動脈夾層轉化的原因進行探究,隨訪觀察腔內修復術后可能發(fā)生的并發(fā)癥并尋找預防和處理的方法。結果本研究術中共植入主動脈覆膜支架51枚(選用進口支架43枚,選用國產(chǎn)支架8枚),其中3例置入2枚支架,2例植入三枚支架。沒有術中發(fā)生死亡或因病情需要轉為開胸手術的患者。所有的患者隨訪時間截止到2013年12月,術后30天內共死亡2例,失訪2例,隨訪41例。平均隨訪31.3±23.7月。隨訪過程中有7例患者發(fā)生Ⅰ型內漏,其中有2例為內漏量大進行短支架(Cuff)植入治療,其余5例均表現(xiàn)為少量內漏,未行處理,在隨訪過程中2例內漏自行消失。腔內修復術后假腔的轉歸主要有以下的類型:近端假腔消失(14/45,31.1%)、假腔內血栓形成機化(31/45,68.9%)、夾層的遠端假腔仍有血流(27/45,60%)。結論作為治療Stanford B型主動脈夾層的一種安全并且行之有效的治療選擇,腔內隔絕術有令人滿意的中期治療效果,實施胸主動脈腔內隔絕術的最佳的時機是亞急性期,在條件滿足的情況下要盡可能的避免在急性期進行腔內修復術,術后進行定期隨訪對提高患者的生存質量具有重大意義。
[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：1645445