本文選題：主動(dòng)脈夾層 + 腔內(nèi)治療��； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年06期

【摘要】：目的:分析Stanford B型主動(dòng)脈夾層累及腹腔四分支血管灌注不良情況,探討腔內(nèi)修復(fù)術(shù)對(duì)腹腔四分支血管灌注的影響。方法:回顧性分析2015年9月至2016年3月收治并確診為Stanford B型主動(dòng)脈夾層的患者32例,男28例,平均年齡(52.9±9.6)歲(32~70歲),收集患者的臨床影像學(xué)資料及隨訪結(jié)果�；贜agamine分支血管灌注不良細(xì)化分型,分析術(shù)前和術(shù)后主動(dòng)脈CT血管造影(computed tomography angiography,CTA)影像資料,對(duì)灌注不良的腹腔四分支血管(腹腔干動(dòng)脈、腸系膜上動(dòng)脈、左腎動(dòng)脈及右腎動(dòng)脈)進(jìn)行分類和統(tǒng)計(jì)學(xué)分析。結(jié)果:32例患者腹腔四分支血管共128支,其中86支分支血管(67.2%)屬于Ⅰ類灌注不良,Ⅰ-a亞型占60.9%(78/128),Ⅰ-b亞型占0.8%(1/128),Ⅰ-c亞型占5.5%(7/128);14支分支血管(10.9%)屬于Ⅱ類灌注不良,Ⅱ-a亞型占3.9%(5/128),Ⅱ-b-1亞型占3.9%(5/128),Ⅱ-b-2亞型占3.1%(4/128);16支分支血管(12.5%)屬于Ⅲ類灌注不良,均為Ⅲ-a亞型(無(wú)Ⅲ-b和Ⅲ-c亞型);其余12支分支血管未受累。32例患者均完成了胸主動(dòng)脈腔內(nèi)修復(fù)術(shù)(thoracic endovascular aortic repair,TEVAR),手術(shù)成功率100%,術(shù)后平均隨訪4個(gè)月。術(shù)后復(fù)查CTA顯示,14支(10.9%)屬于"高危"灌注不良亞型(Ⅰ-b、Ⅰ-c和Ⅱ-b-2亞型)的分支血管中,13支(92.9%)灌注不良明顯改善,其余1支的灌注亞型由Ⅰ-b轉(zhuǎn)歸為Ⅰ-c。結(jié)論:Stanford B型主動(dòng)脈夾層累及腹腔四分支血管灌注明顯受損所占的比例較低,TEVAR能有效改善分支血管的灌注不良狀態(tài),推廣Nagamine分支血管灌注不良細(xì)化分型,對(duì)判斷夾層受累分支血管灌注不良狀況及指導(dǎo)是否分支血管腔內(nèi)重建意義重大。
[Abstract]:Objective: to analyze the effect of four branches of Stanford B aortic dissection involving intraperitoneal instillation, and to explore the effect of endovascular repair on intraperitoneal four branch vascular perfusion. Methods: a retrospective analysis of 32 patients with Stanford B aortic dissection from September 2015 to March 2016 and 28 male patients with an average age of (52.9 + 9.6) years (32~70) The clinical imaging data and follow-up results of the patients were collected. Based on the Nagamine branch perfusion poor classification, the preoperative and postoperative aortic CT angiography (computed tomography angiography, CTA) images were analyzed, and the four branches of abdominal artery, superior mesenteric artery, left renal artery and right kidney with poor perfusion were analyzed. Results: there were 128 branches of four branches in the abdominal cavity of 32 patients, of which 86 branch vessels (67.2%) belonged to type I poor perfusion, I -a subtype accounted for 60.9% (78/128), I -b subtype accounted for 0.8% (1/128), I -c subtype 5.5% (7/128); 14 branch vessels (10.9%) belonged to class II perfusion poor, II -a subtype 3.9% (5/128), The subtype of II -b-1 accounted for 3.9% (5/128), the subtype of II -b-2 accounted for 3.1% (4/128), and 16 branch vessels (12.5%) belonged to class III poor perfusion, all of which were III -a subtype (no III -b and III -c subtype). The remaining 12 branches of the blood vessels were not involved in the thoracic aorta endovascular repair (thoracic endovascular aortic repair,), and the operation success rate was 100%. The operation rate was 100%. The operation rate was performed. The operation rate was 100%. The operation rate was successful. The operation rate was 100%, the operation rate was performed. The operation rate was 100%. The operation rate was successful. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was successful. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was successful. The operation rate was 100%. The operation rate was 100%, the operation rate was 100%, the operation rate was performed. After an average follow-up of 4 months, the postoperative review of CTA showed that 14 (10.9%) belonged to the branch vessels of "high risk" subtype of perfusion (I -b, I -c and II -b-2 subtype), 13 (92.9%) instillation significantly improved, and the other 1 subtypes were transferred from I -b to I conclusion: Stanford B type aortic dissection involved four branch vascular perfusion in the abdominal cavity. The proportion of the loss is low. TEVAR can effectively improve the poor perfusion state of the branch vessels and popularize the poor classification of Nagamine branch perfusion. It is of great significance to judge the poor perfusion of the interlayer and to guide the reconstruction of the intravascular endovascular reconstruction.

【作者單位】： 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院介入診療科北京市心肺血管疾病研究所;
【分類號(hào)】：R654.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 蔡建輝,謝春巖,郭敏,王蘭;主動(dòng)脈夾層19例[J];第四軍醫(yī)大學(xué)學(xué)報(bào);2004年20期

2 許迪,馬文珠;主動(dòng)脈夾層五例[J];南京醫(yī)學(xué)院學(xué)報(bào);1993年01期

3 李孟玲,陳堅(jiān);主動(dòng)脈夾層41例分析[J];中國(guó)實(shí)用內(nèi)科雜志;2001年01期

4 徐冬梅,范崇倫,張梅,李光;主動(dòng)脈夾層106例臨床分析[J];山東醫(yī)藥;2003年10期

5 齊紅娟,周秀琴;主動(dòng)脈夾層二例誤診分析[J];臨床誤診誤治;2003年05期

6 歐強(qiáng),張賽丹,蔣連保,莫龍;主動(dòng)脈夾層(附8例分析并文獻(xiàn)復(fù)習(xí))[J];中國(guó)現(xiàn)代醫(yī)學(xué)雜志;2003年22期

7 史舉彤,鄭磊,魏振宇,范欽明,孫鵬飛,賴永豐;升主動(dòng)脈夾層并發(fā)主動(dòng)脈瓣關(guān)閉不全3例外科治療[J];中國(guó)心血管病研究雜志;2004年06期

8 常麗娟;;主動(dòng)脈夾層12例的臨床診治[J];中國(guó)醫(yī)藥導(dǎo)報(bào);2007年12期

9 范瑞新;;主動(dòng)脈夾層的外科治療[J];嶺南心血管病雜志;2007年03期

10 郭應(yīng)強(qiáng);張爾永;蒙煒;石應(yīng)康;;急性A型主動(dòng)脈夾層手術(shù)主動(dòng)脈斷端加固方法的改進(jìn)[J];中國(guó)胸心血管外科臨床雜志;2009年05期

相關(guān)會(huì)議論文 前10條

1 卞偉湘;梁紹敏;;以腹痛為首發(fā)表現(xiàn)的主動(dòng)脈夾層三例[A];2005年全國(guó)危重病急救醫(yī)學(xué)學(xué)術(shù)會(huì)議學(xué)術(shù)論文集[C];2005年

2 張伸;陳長(zhǎng)志;薛松;成少飛;陳彤宇;;主動(dòng)脈夾層高危因素的臨床分析[A];中華醫(yī)學(xué)會(huì)第七次全國(guó)胸心血管外科學(xué)術(shù)會(huì)議暨2007中華醫(yī)學(xué)會(huì)胸心血管外科青年醫(yī)師論壇論文集心血管外科分冊(cè)[C];2007年

3 袁慧鋒;韓新巍;李臻;任建莊;;急性A型主動(dòng)脈夾層的介入和手術(shù)聯(lián)合治療[A];中華醫(yī)學(xué)會(huì)第十八次全國(guó)放射學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2011年

4 張建;劉達(dá)興;徐剛;梁貴友;牛義民;蔡慶勇;宋永祥;李劍;陳成;王峰;黃德榮;;主動(dòng)脈夾層的外科治療[A];貴州省醫(yī)學(xué)會(huì)胸心血管外科分會(huì)2010年學(xué)術(shù)年會(huì)論文集[C];2010年

5 侯文明;池一凡;牛兆倬;孫龍;生偉;林明山;;馬方氏綜合征合并主動(dòng)脈夾層的外科治療[A];中華醫(yī)學(xué)會(huì)第十五次全國(guó)心血管病學(xué)大會(huì)論文匯編[C];2013年

6 徐雪;黃海威;;以肩臂痛表現(xiàn)起病的主動(dòng)脈夾層1例[A];中華醫(yī)學(xué)會(huì)第十三次全國(guó)神經(jīng)病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2010年

7 常謙;孫立忠;劉永民;朱俊明;于存濤;董超;鄭軍;;主動(dòng)脈夾層的外科治療策略[A];中華醫(yī)學(xué)會(huì)第七次全國(guó)胸心血管外科學(xué)術(shù)會(huì)議暨2007中華醫(yī)學(xué)會(huì)胸心血管外科青年醫(yī)師論壇論文集心血管外科分冊(cè)[C];2007年

8 李軍;楊康;廖克龍;曾會(huì)昌;王明榮;;A型主動(dòng)脈夾層的外科診治[A];中華醫(yī)學(xué)會(huì)第七次全國(guó)胸心血管外科學(xué)術(shù)會(huì)議暨2007中華醫(yī)學(xué)會(huì)胸心血管外科青年醫(yī)師論壇論文集心血管外科分冊(cè)[C];2007年

9 徐國(guó)斌;蔡臘泉;劉俊方;;主動(dòng)脈夾層術(shù)后截癱繼發(fā)骨關(guān)節(jié)病和軟組織鈣化一例[A];中華醫(yī)學(xué)會(huì)第十三屆全國(guó)放射學(xué)大會(huì)論文匯編（下冊(cè)）[C];2006年

10 張菁;;連續(xù)腎臟替代治療在主動(dòng)脈夾層圍術(shù)期的應(yīng)用[A];中華醫(yī)學(xué)會(huì)第五次全國(guó)重癥醫(yī)學(xué)大會(huì)論文匯編[C];2011年

相關(guān)重要報(bào)紙文章 前10條

1 第二軍醫(yī)大學(xué)附屬長(zhǎng)海醫(yī)院血管外科 莊郁峰;升主動(dòng)脈夾層 微創(chuàng)治療獲突破[N];健康報(bào);2013年

2 本報(bào)記者 胡珉琦;主動(dòng)脈夾層：廣泛潛伏的體內(nèi)炸彈[N];北京科技報(bào);2010年

3 通訊員 柳輝艷　記者 程守勤;主動(dòng)脈夾層越早手術(shù)越好[N];健康報(bào);2011年

4 哈爾濱醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院心外科主任 劉宏宇 本報(bào)記者 衣曉峰 整理;主動(dòng)脈夾層手術(shù) 降溫可以悠著點(diǎn)[N];健康報(bào);2012年

5 第二軍醫(yī)大學(xué)附屬長(zhǎng)海醫(yī)院血管外科 景在平 孫羽東 莊郁峰;攻克禁區(qū) 升主動(dòng)脈夾層可微創(chuàng)[N];健康報(bào);2013年

6 記者 唐曉安　通訊員 涂曉晨 吳惠亮;完成全省首例主動(dòng)脈夾層“雜交手術(shù)”[N];湖北日?qǐng)?bào);2008年

7 吳興�！“诐�;外國(guó)醫(yī)生自費(fèi)組團(tuán)到安貞醫(yī)院學(xué)手術(shù)[N];北京日?qǐng)?bào);2009年

8 本報(bào)記者 吳紅月;“孫氏手術(shù)”創(chuàng)新十年 期待更多患者受益[N];科技日?qǐng)?bào);2013年

9 章希煒 董劍;手術(shù)有了三大變化[N];健康報(bào);2007年

10 哈醫(yī)大附屬第一醫(yī)院血管外科主任 劉冰 整理 衣曉峰 王雪;感染性腹主動(dòng)脈瘤 早診最難[N];健康報(bào);2014年

，

本文編號(hào)：1833706