CAJ | 학술논문

目的总结主动脉腔内修复术(EVAR)治疗DeBakey Ⅲ型主动脉夹层适应证的选择、临床疗效以及探讨并发症的防治原则.方法 2002年12月至2007年6月采用TALENT带膜支架施行EVAR治疗75例DeBakeyⅢ型主动脉夹层患者,男65例,女10例,平均年龄54.4±12.6(29～83)岁.1例29岁女性病因考虑为埃-当综合征,2例年青男性分别继发于原发性醛固酮增多症和外伤车祸.全部患者均经螺旋CT或磁共振血管造影检查确诊.全身麻醉下经股动脉置入带膜血管内支架,封堵原发破口,重复造影检查.结果 75例患者共置入81枚带膜支架.其中2例因近端破口接近左锁骨下动脉,先行颈总动脉-锁骨下动脉旁路移植术,再置入支架,支架近段覆盖左锁骨下动脉.25例支架置入后出现明显内漏,20例予球囊扩张,6例置入1枚短支架后内漏消失.支架置入技术成功率为100％.1例埃-当综合征女性患者术中出现股动脉、髂外动脉、髂总动脉广泛血管撕裂,失血性休克,经抢救好转恢复.2例术后早期死于夹层破裂.术后随访1～24个月,2例(包括1例埃-当综合征患者)术后半年发生猝死,1例术后1年复查CT发现支架远端出现破口,经外科手术治疗后恢复良好;其余存活者复查螺旋CT示假腔径缩小并见腔内血栓形成,真腔径增大,无瘤体破裂、内漏及支架移位等并发症发生.结论 EVAR治疗DeBakeyⅢ型主动脉夹层具有技术可靠、创伤小、术后恢复快、成功率高等优点,尤其适用于不能耐受传统开胸手术的老年高危患者.而对于年轻的主动脉夹层患者要注意排除埃-当综合征等遗传性疾病,用EVAR治疗埃-当综合征的血管并发症,目前尚未见报道,其手术并发症及疗效有待进一步观察.
목적 총결주동맥강내수복술(EVAR)치료DeBakey Ⅲ형주동맥협층괄응증적선택、림상료효이급탐토병발증적방치원칙.방법 2002년12월지2007년6월채용TALENT대막지가시행EVAR치료75례DeBakeyⅢ형주동맥협층환자,남65례,녀10례,평균년령54.4±12.6(29～83)세.1례29세녀성병인고필위애-당종합정,2례년청남성분별계발우원발성철고동증다증화외상차화.전부환자균경라선CT혹자공진혈관조영검사학진.전신마취하경고동맥치입대막혈관내지가,봉도원발파구,중복조영검사.결과 75례환자공치입81매대막지가.기중2례인근단파구접근좌쇄골하동맥,선행경총동맥-쇄골하동맥방로이식술,재치입지가,지가근단복개좌쇄골하동맥.25례지가치입후출현명현내루,20례여구낭확장,6례치입1매단지가후내루소실.지가치입기술성공솔위100％.1례애-당종합정녀성환자술중출현고동맥、가외동맥、가총동맥엄범혈관시렬,실혈성휴극,경창구호전회복.2례술후조기사우협층파렬.술후수방1～24개월,2례(포괄1례애-당종합정환자)술후반년발생졸사,1례술후1년복사CT발현지가원단출현파구,경외과수술치료후회복량호;기여존활자복사라선CT시가강경축소병견강내혈전형성,진강경증대,무류체파렬、내루급지가이위등병발증발생.결론 EVAR치료DeBakeyⅢ형주동맥협층구유기술가고、창상소、술후회복쾌、성공솔고등우점,우기괄용우불능내수전통개흉수술적노년고위환자.이대우년경적주동맥협층환자요주의배제애-당종합정등유전성질병,용EVAR치료애-당종합정적혈관병발증,목전상미견보도,기수술병발증급료효유대진일보관찰.
Objective To investigate the clinical therapeutic effects of endovascular repair for patients with DeBakey Ⅲ aortic dissection.Methods From December 2002 to June 2007,endovascular TALENT stent-graft exclusion was performed in 75(65 males,mean age 54.4±12.6 years)patients with DeBakey Ⅲ aortic dissection(1 young woman due to Ehlers-Danlos syndrome,2 young men due to primary aldosteronism and trauma respectively).All patients were diagnosed by contrast enhanced computed tomography(CT)or MRI.Stent-grafts were deployed via femoral artery to exclude the tear of dissection.Aortic angiography was performed immediately after procedure.Results Eighty-one stent-grafts were installed in 75 patients successfully without operation related dissection.Endoleakage immediately after stent-graft deploying was evidenced in 25 patients and disappeared after stent placements(n=6)or balloon dilation (n=19).Two patients died from aortic rupture within 2 days after procedure.Iliac artery was torn in a female patient with Ehlers-Danlos syndrome,this patient developed hemorrhagic shock after stent-graft placement and recovered after anti-shock treatments and iliac artery replacement with synthetic artery.During the follow-up of 1-24 months,2 patients(including the woman with Ehlers-Danlos syndrome)suddenly died half a year after procedure.The remaining patients were alive and well.Repeat CT during follow up showed that reduced lumen size and thrombosis in the false lumen.There was no aortic rupture,endoleak and stent migration during the follow-up period except descending aortic dissection distal of the stent-graft in 1 patient 1 year after procedure and the patient were successfully treated surgically without complication.Conclusions Endovasular repair is a safe and effective treatment for patients with DeBakey Ⅲ aortic dissection,suitable for old patients with high risk of surgery.Ehlers-Danlos syndrome should be considered in young DeBakey Ⅲ aortic dissection patients without hypertension.Further studies are warranted on endovasular repair therapy for artery complication of Ehlers-Danlos syndrome.