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目的:观察血管内带膜支架在主动脉夹层中应用的有效性、可行性和安全性。方法:选择2005-03/2006-03在赣南医学院第一附属医院心内科收治的6例主动脉夹层动脉瘤患者,男3例,女3例;年龄32～67岁,平均50岁。均经胸部MRI检查及主动脉造影确诊,且符合DeBakey分型为Ⅲ型主动脉夹层。瘤体直径最大4.3cm,最小3.2cm。所有患者对手术项目均知情同意。患者发病2周后,控制血压在90～110/60～70mmHg,心率在60～65次/min情况下全麻状态下进行分别置入直筒和分叉支架(均为愈恒佳公司生产,覆膜类型为单裸头,支架均以镍钛记忆合金为材料,外覆薄层国产人造血管)。采用血管照影观察患者术后胸主动脉夹层消失情况并观察患者术后一般情况,于术后3,12个月螺旋CT复查患者恢复情况。结果:纳入患者6例均进入结果分析。①术后胸主动脉夹层消失及一般情况:6例选择的支架直径选择恰当,术后造影4例夹层消失,假腔内血栓形成,2例患者胸主动脉段夹层消失,仍可见少量造影剂内漏至假腔,但血流较缓慢。术后患者一般情况良好,生命体征平稳,均于7￣10d出院。②CT复查结果:术后3个月复查螺旋CT显示原假腔明显缩小,真腔增大接近正常。病例3可见支架折曲远端与支架血管内壁相连的小块状不规则附壁血栓形成,随访血栓增大不明显。术后12个月患者支架位置及形态均未见明显改变,生活质量明显好转。结论:血管内带膜支架在主动脉夹层中的应用是有效、可行和安全的。
Objective: To observe the effectiveness, feasibility and safety of intravascular stent implantation in aortic dissection. Methods: Six patients with aortic dissecting aneurysm admitted to the First Affiliated Hospital of Gannan Medical College from March 2005 to March 2006 were selected. There were 3 males and 3 females, aged 32-67 years (average 50 years). All were confirmed by chest MRI and aortic angiography, and in line with DeBakey type Ⅲ aortic dissection. Tumor diameter of the largest 4.3cm, the smallest 3.2cm. All patients were informed of the surgical items. Two weeks after the onset of the disease, the control blood pressure was 90 ~ 110/60 ~ 70mmHg, heart rate was 60 ~ 65 times / min under general anesthesia were placed straight and bifurcated stent (all the more constant good company, Film type is a bare head, stent are nickel-titanium memory alloy material, covered with a thin layer of domestic artificial blood vessels). The disappearance of the thoracic aortic dissection was observed with blood vessel photography and the postoperative general condition was observed. The recovery of the patients was reviewed by spiral CT at 3 and 12 months after operation. Results: Six patients were involved in the analysis of the results. ①After operation, the disappearance of thoracic aortic dissection and the general situation: the diameter of stent was selected in 6 cases, the dissection disappeared in 4 cases, thrombus in false lumen and disappearance of thoracic aortic dissection in 2 cases. Internal leakage to the false lumen, but the blood flow is slower. Postoperative patients generally good, stable vital signs, were discharged in 7 ~ 10d. ② CT review results: 3 months after the review of spiral CT showed a significant reduction of the original false lumen, true lumen enlargement close to normal. Case 3 shows the distal end of stent flexion and stent vessel wall connected to the small irregular parietal thrombosis, follow-up increased thrombus was not obvious. At 12 months after operation, no significant changes were found in the position and shape of the stent, and the quality of life improved significantly. Conclusion: The application of endovascular stent graft in aortic dissection is effective, feasible and safe.