中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
12期
908-910
,共3页
常光其%李梓伦%姚陈%殷恒讳%李松奇%李晓曦%王劲松%胡作军%王冕
常光其%李梓倫%姚陳%慇恆諱%李鬆奇%李曉晞%王勁鬆%鬍作軍%王冕
상광기%리재륜%요진%은항휘%리송기%리효희%왕경송%호작군%왕면
手术后并发症%血管成形术%主动脉夹层
手術後併髮癥%血管成形術%主動脈夾層
수술후병발증%혈관성형술%주동맥협층
Postoperative complications%Angioplasty%Aortic dissection
目的 总结Stanford B型主动脉夹层(TB-AD)腔内修复术中远期并发症的治疗经验.方法 对2001年1月至2013年5月因TB-AD在中山大学附属第一医院进行血管腔内修复术(thoracic endovascular aortic repair,TEVAR)的能够进行全程随访的156例患者资料进行回顾性分析.结果 156例患者TEVAR手术均获成功,成功率100％.封堵左锁骨下动脉(left subclavian artery,LSA) 32例,烟囱支架重建LSA 8例;封堵左颈总动脉(left common carotid artery,LCCA)1例,烟囱支架重建LCCA 1例.术后内漏25例(16.0％),脑梗死4例(2.6％),入路并发症5例(3.2％),住院30 d死亡5例(3.2％).平均随访(49±42)个月,随访期间死亡12例(8.8％),其中9例死因与夹层相关;旁路吻合口瘘/假性动脉瘤1例(0.6％),夹层逆行撕裂1例(0.6％),穿刺入路侧下肢缺血2例(1.3％).二次腔内手术4例(2.6％),1个月内漏6例(3.9％). 结论 TB-AD腔内修复术中远期随访结果满意,夹层破裂为导致死亡最严重的中远期并发症,密切随访可早发现和处理其潜在的危险因素.
目的 總結Stanford B型主動脈夾層(TB-AD)腔內脩複術中遠期併髮癥的治療經驗.方法 對2001年1月至2013年5月因TB-AD在中山大學附屬第一醫院進行血管腔內脩複術(thoracic endovascular aortic repair,TEVAR)的能夠進行全程隨訪的156例患者資料進行迴顧性分析.結果 156例患者TEVAR手術均穫成功,成功率100％.封堵左鎖骨下動脈(left subclavian artery,LSA) 32例,煙囪支架重建LSA 8例;封堵左頸總動脈(left common carotid artery,LCCA)1例,煙囪支架重建LCCA 1例.術後內漏25例(16.0％),腦梗死4例(2.6％),入路併髮癥5例(3.2％),住院30 d死亡5例(3.2％).平均隨訪(49±42)箇月,隨訪期間死亡12例(8.8％),其中9例死因與夾層相關;徬路吻閤口瘺/假性動脈瘤1例(0.6％),夾層逆行撕裂1例(0.6％),穿刺入路側下肢缺血2例(1.3％).二次腔內手術4例(2.6％),1箇月內漏6例(3.9％). 結論 TB-AD腔內脩複術中遠期隨訪結果滿意,夾層破裂為導緻死亡最嚴重的中遠期併髮癥,密切隨訪可早髮現和處理其潛在的危險因素.
목적 총결Stanford B형주동맥협층(TB-AD)강내수복술중원기병발증적치료경험.방법 대2001년1월지2013년5월인TB-AD재중산대학부속제일의원진행혈관강내수복술(thoracic endovascular aortic repair,TEVAR)적능구진행전정수방적156례환자자료진행회고성분석.결과 156례환자TEVAR수술균획성공,성공솔100％.봉도좌쇄골하동맥(left subclavian artery,LSA) 32례,연창지가중건LSA 8례;봉도좌경총동맥(left common carotid artery,LCCA)1례,연창지가중건LCCA 1례.술후내루25례(16.0％),뇌경사4례(2.6％),입로병발증5례(3.2％),주원30 d사망5례(3.2％).평균수방(49±42)개월,수방기간사망12례(8.8％),기중9례사인여협층상관;방로문합구루/가성동맥류1례(0.6％),협층역행시렬1례(0.6％),천자입로측하지결혈2례(1.3％).이차강내수술4례(2.6％),1개월내루6례(3.9％). 결론 TB-AD강내수복술중원기수방결과만의,협층파렬위도치사망최엄중적중원기병발증,밀절수방가조발현화처리기잠재적위험인소.
Objective To analyze the mid-to long-term complications of endovascular repair for Stanford type B aortic dissection (TB-AD).Methods Data of 156 consecutive TB-AD patients treated by thoracic endovascular aortic repair (TEVAR) in our center from January 2001 to May 2013 were analyzed retrospectively.Results Technical success was achieved in all cases.Left subclavian artery (LSA) was covered in 32 cases,and reconstructed by chimney graft in 8 cases.Left common carotid artery (LCCA) was covered in 1 case and reconstructed by chimney graft in 1 case.Postoperative endoleak,stroke,access complication,and in-hospital 30-day mortality were observed in 25 (16.0％),4 (2.6％),5 (3.2％),and 5 (3.2％) cases,respectively.During the follow-up of (49 ± 42) months,there were 12 (8.8％)deaths,including 9 dying of aortic dissection.There was 1 bypass anastomotic fistula/pseudoaneurysm,1 stent-graft induced retrograde type A dissection,and 2 of lower limb ischemia secondary to femoral artery access.Re-intervention was performed in 4 cases (2.6％),and within 1-month endoleak was observed in 6 cases (3.9％).Conclusions The mid-to long-term result of endovascular repair for TB-AD are satisfactory.Rupture of aortic dissection is the most serious mid-to long-term complication.Intensive followup is needed to detect and manage the potential risk factors.
