中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2011年
9期
755-757
,共3页
章希炜%杨宏宇%邹君杰%马昊
章希煒%楊宏宇%鄒君傑%馬昊
장희위%양굉우%추군걸%마호
主动脉疾病%人工血管%支架
主動脈疾病%人工血管%支架
주동맥질병%인공혈관%지가
Aortic diseases%Blood vessel prosthesis%Stents
目的 探讨症状性主动脉穿透性溃疡（penetrating atherosclerotic ulcer，PAU）的临床诊断和支架型人工血管腔内修复术的临床价值。方法 回顾分析2004年9月至2010年4月治疗的12例症状性PAU患者的临床资料，所有患者均有突发胸背部疼痛等急性主动脉综合征的临床表现，计算机断层扫描血管成像（computer tomography angiography，CTA）确诊为Stanford B型PAU，其中8例合并主动脉壁间血肿，所有患者均在全麻下接受支架型人工血管腔内修复术，两例附加杂交旁路手术延长近远侧锚定区。本组12例中10例患者获得随访，随访率83.3％。随访时间1～4年（中位时间36个月），随访率83.3％ (10/12)。结果 12例患者共植入支架型人工血管12枚，其中植入支架直径32～40 mm，平均(35.7 ±2.5) mm，长度152 ～ 202 mm，平均(163±19) mm。1例溃疡较大病例支架人工血管植入后存在极少量内漏外，其他溃疡均隔绝满意。技术成功率100％。围手术期无不良事件发生。随访中患者无症状复发及死亡。CTA检查结果满意无内漏，1例少量内漏患者术后3个月复查内漏消失。结论 支架型人工血管腔内修复术因其微创、有效可能成为现阶段症状性PAU的首选治疗手段，术后严格的血压控制是长期疗效的有效保证。
目的 探討癥狀性主動脈穿透性潰瘍（penetrating atherosclerotic ulcer，PAU）的臨床診斷和支架型人工血管腔內脩複術的臨床價值。方法 迴顧分析2004年9月至2010年4月治療的12例癥狀性PAU患者的臨床資料，所有患者均有突髮胸揹部疼痛等急性主動脈綜閤徵的臨床錶現，計算機斷層掃描血管成像（computer tomography angiography，CTA）確診為Stanford B型PAU，其中8例閤併主動脈壁間血腫，所有患者均在全痳下接受支架型人工血管腔內脩複術，兩例附加雜交徬路手術延長近遠側錨定區。本組12例中10例患者穫得隨訪，隨訪率83.3％。隨訪時間1～4年（中位時間36箇月），隨訪率83.3％ (10/12)。結果 12例患者共植入支架型人工血管12枚，其中植入支架直徑32～40 mm，平均(35.7 ±2.5) mm，長度152 ～ 202 mm，平均(163±19) mm。1例潰瘍較大病例支架人工血管植入後存在極少量內漏外，其他潰瘍均隔絕滿意。技術成功率100％。圍手術期無不良事件髮生。隨訪中患者無癥狀複髮及死亡。CTA檢查結果滿意無內漏，1例少量內漏患者術後3箇月複查內漏消失。結論 支架型人工血管腔內脩複術因其微創、有效可能成為現階段癥狀性PAU的首選治療手段，術後嚴格的血壓控製是長期療效的有效保證。
목적 탐토증상성주동맥천투성궤양（penetrating atherosclerotic ulcer，PAU）적림상진단화지가형인공혈관강내수복술적림상개치。방법 회고분석2004년9월지2010년4월치료적12례증상성PAU환자적림상자료，소유환자균유돌발흉배부동통등급성주동맥종합정적림상표현，계산궤단층소묘혈관성상（computer tomography angiography，CTA）학진위Stanford B형PAU，기중8례합병주동맥벽간혈종，소유환자균재전마하접수지가형인공혈관강내수복술，량례부가잡교방로수술연장근원측묘정구。본조12례중10례환자획득수방，수방솔83.3％。수방시간1～4년（중위시간36개월），수방솔83.3％ (10/12)。결과 12례환자공식입지가형인공혈관12매，기중식입지가직경32～40 mm，평균(35.7 ±2.5) mm，장도152 ～ 202 mm，평균(163±19) mm。1례궤양교대병례지가인공혈관식입후존재겁소량내루외，기타궤양균격절만의。기술성공솔100％。위수술기무불량사건발생。수방중환자무증상복발급사망。CTA검사결과만의무내루，1례소량내루환자술후3개월복사내루소실。결론 지가형인공혈관강내수복술인기미창、유효가능성위현계단증상성PAU적수선치료수단，술후엄격적혈압공제시장기료효적유효보증。
Objective To evaluate endovascular repair(EVAR) of penetrating atherosclerotic ulcer (PAU) of the thoracic aorta. Methods There were 12 cases of PAU treated at our department. All the cases had severe acute thoracic pain. Computer tomography angiography (CTA) showed well outlined ulcer in 12 cases, intramural hematoma in 8 cases. EVARs were done under general anaesthesia and 12 stent grafts were used. Two cases received by-pass procedure ahead of EVARs because of main branches involved.Patients were followed up with CTA from 12 months to 4 years( median 36 months). Results A total of 12 stent grafts were implanted to 12 patients. The average diameter of stent graft was ( 35.7 ± 2. 5 ) mm(32-40 mm) , length was ( 163 ± 19) mm ( 152-202 mm). There was a very small internal leakage in one case with large size ulcer after implantation of stent graft, other ulcers were excluded completely. Primary technical success rate was 100％. There were no perioperative death and severe complications. All cases were free from symptoms after operation and alive during follow-up. CTA showed satisfactory results without internal leakage. The small leakage in the case disappeared within 3 months.Conclusions Being miniinvasive and effective, EVAR is the choice of therapy for symptomatic PAU.
