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目的介绍应用带膜血管腔内支架植入术治疗Stanford B型胸主动脉夹层的方法和效果。方法对29例(男25例,女4例,年龄38~77岁)胸主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析。术前采用CT血管成像(CTA)、磁共振血管成像(MRA)技术或CT对主动脉夹层动脉瘤进行评估,术前穿刺左肱动脉行升主动脉对比剂追踪了解破口的位置及撕裂的范围,所有的患者都在全麻下进行的,术中在数字减影血管造影机监视下经股动脉或髂动脉将带膜支架导入胸主动脉封闭夹层破口。结果29例均成功进行了胸主动脉夹层的血管腔内隔绝术,其中25例使用Talent支架,4例为国产支架。术后主动脉造影证实夹层裂口完全封闭或内漏明显减少,无中转开胸手术,围手术期无死亡及严重并发症发生。术后随访3~29个月(平均15个月),其中21例行CT复查,8例行DSA复查,3例病人在术后2~8个月行心脏瓣膜置换术。结论带膜支架腔内隔绝术是治疗胸主动脉夹层动脉瘤的简便安全而有效的方法,近期疗效好。手术死亡率和并发症发生率低,手术成功率和生存率高。
Objective To introduce the method and effect of using endovascular stent graft in the treatment of Stanford type B thoracic aortic dissection. Methods The clinical data of 29 cases (25 males, 4 females, 38-77 years old) with endovascular dissection of thoracic aortic dissecting aneurysm were analyzed retrospectively. Preoperative CT angiography (CTA), magnetic resonance angiography (MRA) or CT on the evaluation of aortic dissection, preoperative puncture of the left brachial artery ascending aorta contrast agent to track the location of the tear and tear Of all patients were under general anesthesia, surgery during the digital subtraction angiography machine through the femoral artery or iliac artery with a stent graft into the thoracic aorta closed dissection break. Results Twenty-nine patients underwent endovascular endovascular graft exclusion of thoracic aortic dissection. Talent stent was used in 25 cases and domestic stent in 4 cases. Postoperative aortic angiography confirmed complete dissection or internal leakage gap was significantly reduced, no transit thoracotomy, perioperative death and serious complications. The patients were followed up for 3 to 29 months (average 15 months). Among them, 21 were performed CT and 8 were performed DSA. Three patients underwent heart valve replacement 2 to 8 months after operation. Conclusion Endovascular stent-graft exclusion is a safe and effective method for the treatment of thoracic aortic dissection aneurysm. Surgical mortality and complications are low, surgical success and survival rates are high.