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|本期目录/Table of Contents|

B型不典型主动脉夹层的腔内修复术治疗及中期随访结果

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2011年第2期
页码:
247-249
栏目:
临床研究
出版日期:
2010-12-10

文章信息/Info

Title:
Endovascular repair of atypical aortic dissection
作者:
魏以桢; 常谦; 于存涛; 蒙延海
中国医学科学院阜外心血管病医院血管外科中心,北京 100037
Author(s):
WEI Yi-zhen;  CHANG Qian;  YU Cun-tao;  MENG Yan-hai
Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
关键词:
主动脉; 不典型夹层; 腔内治疗; 覆膜支架
Keywords:
aortic;  atypical dissection;  endovascular repair;  stent-graft
分类号:
R543.1
DOI:
-
文献标识码:
A
摘要:
目的: 总结临床较少见的B型主动脉不典型夹层的腔内修复治疗患者的临床资料及中期随访结果。方法： 总结自2009年4月~2009年10月连续10例采用腔内覆膜支架植入术的B型主动脉不典型夹层的临床资料及治疗方法，并进行随访。结果： 所有患者均为男性。年龄（54±11）岁，体质量（80±6） kg。所有患者均有急性胸背部疼痛症状，经64排螺旋CT确诊为B型主动脉不典型夹层，其中8例存在主动脉壁内血肿，9例存在主动脉穿通性溃疡，7例两者共存。3例存在胸腔积液，4例CT提示造影剂外溢。所有患者均有高血压病史，诊断高血压病1～30（8±10）年。最高血压150～230（189±31）mmHg，6例患者诊断有高血脂，7例患者经CT诊断有严重动脉硬化。所有10例患者采用介入腔内覆膜支架修复术，从疼痛症状发生到支架植入时间6～60（19±16） d， 急性患者6例，慢性患者4例。所有患者均成功植入覆膜支架。植入支架直径（35.4±1.9） mm，支架长度（150±9） mm。ICU时间为4 h～2（1.0±0.6） d，术后（5.9±1.5） d出院。其中1例患者同期植入一枚肾动脉支架。1例术后第2天起有轻度偏瘫症状，术后CT证实左侧顶叶小梗死灶，经治疗好转出院。所有患者均进行随访，随访5～11（8.4±2.1）个月。1例术后2周时在家中不明原因猝死。其余患者在术后4 d及术后3个月时均行CT复查，恢复满意，症状消失。结论： 主动脉腔内覆膜支架修复术对有症状且有演变成典型夹层或破裂倾向的B型主动脉不典型夹层治疗的近，中期效果良好，是一种安全，有效，成功率高的治疗方法，远期效果需进一步随访。
Abstract:
AIM: To analyze the clinical data and follow-up results of endovascular repair (EVR) for atypical type B aortic dissection. METHODS: Clinical data and treatment results were analyzed in ten consecutive patients with type B atypical aortic dissection treated with EVR from April 2009 to October 2009 and all patients were followed up. RESULTS: Ten patients were studied. All were male with a mean age of (54±11) years and mean body weight of (80±6) kg. All had severe sharp chest or back pain. Among them, nine patients had penetrating aortic ulcer, eight patients had intramural hematoma, and seven patients had both conditions. Three patients had pleural effusion and four patients had contrast leakage demonstrated by CT scan. All patients had a hypertension history of (8±10) years (1-30 years) with average systolic pressure of (189±31) mmHg. Six of the 10 patients had hyperlipidemia, and seven had severe atherosclerosis and arterial calcification diagnosed by CT scan. Technical success was achieved in all ten patients with a mean diameter of stent graft at (35.4±1.9) mm and mean length of stent graft at (150±9) mm. Mean time interval from pain onset to stent graft implantation was (19±16) days (range: 6-60 days). Average ICU stay was (1.0±0.6) days (4 h, 2 days) and average hospital stay after operation was (5.9±1.5) days. One patient received one renal bare metal stent at the time of EVR. One patient had mild paraplegia and was diagnosed as left occipital cerebral infarction by CT scan. All patients were followed-up for a mean period of (8.4±2.1) months (range: 5-11 months). One patient experienced sudden death at home 2 weeks after operation with unknown cause. Cardiac multidetector computed tomography (MDCT) examination 4 days and 3 months after operation showed satisfactory recovery in all other patients. CONCLUSION: EVR is a safe and effective treatment with a high success rate for symptomatic type B atypical aortic dissection with high risk of rupture. Short-term results are satisfactory but mid- and long-term results need further follow-up.

参考文献/References

[1]Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts［J］. Ann Thorac Surg, 2008, 85(1 suppl):S1-S41.

[2]Nienaber CA, Von Kodolitsch Y, Petersen B, et al. Intramural hemorrhage of the thoracic aorta.diagnostic and theraputic implications［J］. Circulation, 1995, 92(6)：1465-1472.

[3]Sawhney NS, DeMaria AN, Blanchard DG. Aortic Intramural Hematoma, An increasingly recognized and potentially fatal entity［J］. Chest, 2001, 120(4):1340-1346.

[4]Tittle SL, Lynch RJ, Cole PE, et al. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta［J］. J Thorac Cardiovasc Surg, 2002, 123(6):1051-1059.

备注/Memo

备注/Memo:
收稿日期：2010-02-03.基金项目：中央公益性科研院所基本科研基金资助（2007F005） 通讯作者：常谦，主任医师，主要从事成人心血管外科、主动脉外科手术及介入治疗研究Email:chqfw@yahoo.com 作者简介：魏以桢，副主任医师，博士Email:weiyizhen@sohu.com
更新日期/Last Update: 2010-12-10