中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
7期
536-539
,共4页
郭伟%张宏鹏%刘小平%尹太%贾鑫%熊江%马晓辉%张敏宏%梁发启%张国华
郭偉%張宏鵬%劉小平%尹太%賈鑫%熊江%馬曉輝%張敏宏%樑髮啟%張國華
곽위%장굉붕%류소평%윤태%가흠%웅강%마효휘%장민굉%량발계%장국화
动脉瘤,夹层%支架%主动脉弓%腔内修复术%烟囱技术
動脈瘤,夾層%支架%主動脈弓%腔內脩複術%煙囪技術
동맥류,협층%지가%주동맥궁%강내수복술%연창기술
Aneurysm,dissecting%Stents%Aortic arch%Thoracic endovascular aneurysm repair%Chimney
目的 探讨"烟囱"技术在主动脉弓腔内修复术中应用的可行性.方法 针对近端锚定区偏短的主动脉弓病变,在腔内修复过程中先覆盖重要主动脉弓分支血管,然后通过腔内技术在被覆盖的分支血管内行"烟囱"支架置入术.回顾性统计2004年8月至2009年8月应用"烟囱"技术处理病变的临床资料,分析应用"烟囱"技术的原因、方法、结果和并发症状况等.结果 本组共27例主动脉弓病变腔内修复技术中应用了"烟囱"技术,男性25例,女性2例.年龄37～84岁,平均(67.2±3.8)岁.针对无名动脉的"烟囱"技术3例,针对左颈总动脉的"烟囱"技术11例,针对左锁骨下动脉的"烟囱"技术13例.5例术后即刻造影提示存在少量I型内漏(18.5%).1例术中因左颈总动脉穿刺造成了该动脉夹层.1例术后因呼吸衰竭死亡.无中风、出血等并发症发生.随访时间3～60个月,平均(16.8±5.9)个月.1例次要脑梗死,1例"烟囱"支架闭塞.1例术后4年因心肌梗死死亡.所有I型内漏均消失,无支架型血管和"烟囱"支架移位等并发症.结论 "烟囱"技术有效提高了锚定区长度,能很好的降低I型内漏的发生率.但应严格选择适应证,防止可能带来的并发症.
目的 探討"煙囪"技術在主動脈弓腔內脩複術中應用的可行性.方法 針對近耑錨定區偏短的主動脈弓病變,在腔內脩複過程中先覆蓋重要主動脈弓分支血管,然後通過腔內技術在被覆蓋的分支血管內行"煙囪"支架置入術.迴顧性統計2004年8月至2009年8月應用"煙囪"技術處理病變的臨床資料,分析應用"煙囪"技術的原因、方法、結果和併髮癥狀況等.結果 本組共27例主動脈弓病變腔內脩複技術中應用瞭"煙囪"技術,男性25例,女性2例.年齡37～84歲,平均(67.2±3.8)歲.針對無名動脈的"煙囪"技術3例,針對左頸總動脈的"煙囪"技術11例,針對左鎖骨下動脈的"煙囪"技術13例.5例術後即刻造影提示存在少量I型內漏(18.5%).1例術中因左頸總動脈穿刺造成瞭該動脈夾層.1例術後因呼吸衰竭死亡.無中風、齣血等併髮癥髮生.隨訪時間3～60箇月,平均(16.8±5.9)箇月.1例次要腦梗死,1例"煙囪"支架閉塞.1例術後4年因心肌梗死死亡.所有I型內漏均消失,無支架型血管和"煙囪"支架移位等併髮癥.結論 "煙囪"技術有效提高瞭錨定區長度,能很好的降低I型內漏的髮生率.但應嚴格選擇適應證,防止可能帶來的併髮癥.
목적 탐토"연창"기술재주동맥궁강내수복술중응용적가행성.방법 침대근단묘정구편단적주동맥궁병변,재강내수복과정중선복개중요주동맥궁분지혈관,연후통과강내기술재피복개적분지혈관내행"연창"지가치입술.회고성통계2004년8월지2009년8월응용"연창"기술처리병변적림상자료,분석응용"연창"기술적원인、방법、결과화병발증상황등.결과 본조공27례주동맥궁병변강내수복기술중응용료"연창"기술,남성25례,녀성2례.년령37～84세,평균(67.2±3.8)세.침대무명동맥적"연창"기술3례,침대좌경총동맥적"연창"기술11례,침대좌쇄골하동맥적"연창"기술13례.5례술후즉각조영제시존재소량I형내루(18.5%).1례술중인좌경총동맥천자조성료해동맥협층.1례술후인호흡쇠갈사망.무중풍、출혈등병발증발생.수방시간3～60개월,평균(16.8±5.9)개월.1례차요뇌경사,1례"연창"지가폐새.1례술후4년인심기경사사망.소유I형내루균소실,무지가형혈관화"연창"지가이위등병발증.결론 "연창"기술유효제고료묘정구장도,능흔호적강저I형내루적발생솔.단응엄격선택괄응증,방지가능대래적병발증.
Objective To evaluate the feasibility of chimney technique during thoracic endovascular aneurysm repair(TEVAR) in aortic arch lesions. Methods The stent-graft was deployed covering super arch branch artery in arch lesions in case there was not enough landing zone. A chimney stent was put in the super arch branch artery. We retrospectively analyzed the data of this group, aiming at summarizing the indications, methods, results and complications of chimney technique. Results From August 2004 to August 2009, 27 aortic arch lesions were treated by TEVAR with chimney stent, male/female ratio was 25/2, average age was 67. 2 ±3. 8 years, including3 chimney stents for innominate artery, 11 chimney stents for left common carotid artery and 13 chimney stent for left subclavian artery. Type I endoleaks were encountered in 18. 5% (5/27) of this group by final angiogram. Left common carotid artery dissection was caused by puncture in one case. One patient died of respiratory failure. There was no postoperative stroke nor bleeding. Discharged patients were followed up from 3 to 60 months, averaging at 16. 8 months. There was one death from MI 4 years later. There was minor stroke and left subclavian artery chimney stent occlusion in one each cases during the follow-up. All endoleaks were sealed without stent migration. Conclusion Chimney technique improves the length of landing zone and decreases effectively the endoleak rate.
