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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。
OBJECTIVE: To summarize the clinical data and the follow-up results of endovascular repair of less common type B aortic atypical dissection. Methods: From April 2009 to October 2009, the clinical data and treatment of 10 cases of atypical B-type atherectomy using endovascular stent-graft were summarized and followed up. Results: All patients were male. Age (54 ± 11) years old, body mass (80 ± 6) kg. All patients had acute symptoms of thoracolumbar pain. Sixty-four cases of spiral CT were diagnosed as atypical type B aortic dissection. Among them, there were 8 cases of intra-aortic hematoma, 9 cases of aortic perforation ulcer and 7 cases of both. Pleural effusion was found in 3 cases and CT showed spillover in 4 cases. All patients had a history of hypertension, diagnosis of hypertension 1 ~ 30 (8 ± 10) years. The maximum blood pressure ranged from 150 to 230 (189 ± 31) mmHg. Six patients were diagnosed as having hyperlipidemia and seven were diagnosed with severe arteriosclerosis by CT. All 10 patients underwent endovascular stent-graft repair, ranging from painful symptoms to stent implantation of 6 to 60 (19 ± 16) days, 6 in acute and 4 in chronic patients. All patients were successfully implanted with stent graft. The diameter of stent was (35.4 ± 1.9) mm and the length of stent was (150 ± 9) mm. ICU time was 4 h ~ 2 (1.0 ± 0.6) d, postoperative (5.9 ± 1.5) d was discharged. One case of patients with simultaneous implantation of a renal artery stent. One patient had mild hemiplegia symptoms on the second day after operation. Postoperative CT confirmed a small infarct on the left parietal lobe and was discharged after treatment. All patients were followed up for 5 ~ 11 (8.4 ± 2.1) months. One patient died of unknown causes at home at 2 weeks after surgery. The rest of the patients underwent CT examination 4 days after operation and 3 months after operation, the results were satisfactory and the symptoms disappeared. CONCLUSION: Endovascular stent-graft repair has good effect in near and medium-term on type B aortic atypia dissection with symptomatic symptoms and evolving into typical dissection or rupture tendency. It is a safe, effective and high success rate Treatment, long-term effect needs further follow-up.