CAJ | 학술논문

目的：探讨腔内修复治疗复杂性急性Stanford B型主动脉夹层的短期临床疗效。 　　方法：回顾性分析我院2010-01至2014-06期间行腔内修复治疗的36例复杂性急性Stanford B型主动脉夹层患者的临床资料（包括手术情况及术后计算机断层摄影术血管造影随访情况），其中男性27例，女性9例；年龄41~62（平均43.7）岁。 　　结果：36例患者的腔内修复均获成功。22例行主动脉腔内修复并覆盖左锁骨下动脉开口，10例结合左锁骨下动脉“烟囱”技术行主动脉腔内修复，2例先实施左颈总动脉—左锁骨下动脉人工血管转流后再行腔内修复，2例先实施右颈总动脉—左颈总动脉人工血管转流（左颈总动脉近心端结扎）后再行主动脉腔内修复。内脏动脉及下肢动脉缺血逐渐恢复，无内漏等并发症发生。36例患者中30例患者获得随访，随访率83.33%，随访时间1年。术后1年主动脉夹层全部假腔内血栓形成者10例，部分假腔内血栓形成者20例。与术前比较，术后1年无论是全部假腔内血栓形成者，还是部分假腔内血栓形成者，胸主动脉真腔体积均显著增大[（190.0±68.7）ml vs（125.3±63.4） ml和(166.2±71.8) ml vs（110.1±62.7）ml]，差异均有统计学意义（P<0.001）；而胸主动脉假腔体积均显著缩小[（65.0±67.4）ml vs（185.3±66.6）ml和(132.3±62.6) ml vs（224.5±72.3）ml]，差异均有统计学意义（P<0.001）。对于全部假腔内血栓形成者，与术前比较，术后1年腹主动脉真腔体积显著增大[（55.5±12.4）ml vs（48.6±12.2）ml， P<0.01]；部分假腔内血栓形成者，术后1年腹主动脉假腔体积也显著增大[（58.2±21.5）ml vs（42.5±18.5）ml， P均<0.01]，差异均有统计学意义。 　　结论：对于复杂的主动脉夹层患者行腔内修复，术中结合覆盖左锁骨下动脉、烟囱技术以及小切口的杂交技术等方法可延长锚定区，拓展主动脉夹层的腔内治疗范围，提高腔内修复的疗效，降低并发症的发生，短期疗效良好。目的：探討腔內脩複治療複雜性急性Stanford B型主動脈夾層的短期臨床療效。 　　方法：迴顧性分析我院2010-01至2014-06期間行腔內脩複治療的36例複雜性急性Stanford B型主動脈夾層患者的臨床資料（包括手術情況及術後計算機斷層攝影術血管造影隨訪情況），其中男性27例，女性9例；年齡41~62（平均43.7）歲。 　　結果：36例患者的腔內脩複均穫成功。22例行主動脈腔內脩複併覆蓋左鎖骨下動脈開口，10例結閤左鎖骨下動脈“煙囪”技術行主動脈腔內脩複，2例先實施左頸總動脈—左鎖骨下動脈人工血管轉流後再行腔內脩複，2例先實施右頸總動脈—左頸總動脈人工血管轉流（左頸總動脈近心耑結扎）後再行主動脈腔內脩複。內髒動脈及下肢動脈缺血逐漸恢複，無內漏等併髮癥髮生。36例患者中30例患者穫得隨訪，隨訪率83.33%，隨訪時間1年。術後1年主動脈夾層全部假腔內血栓形成者10例，部分假腔內血栓形成者20例。與術前比較，術後1年無論是全部假腔內血栓形成者，還是部分假腔內血栓形成者，胸主動脈真腔體積均顯著增大[（190.0±68.7）ml vs（125.3±63.4） ml和(166.2±71.8) ml vs（110.1±62.7）ml]，差異均有統計學意義（P<0.001）；而胸主動脈假腔體積均顯著縮小[（65.0±67.4）ml vs（185.3±66.6）ml和(132.3±62.6) ml vs（224.5±72.3）ml]，差異均有統計學意義（P<0.001）。對于全部假腔內血栓形成者，與術前比較，術後1年腹主動脈真腔體積顯著增大[（55.5±12.4）ml vs（48.6±12.2）ml， P<0.01]；部分假腔內血栓形成者，術後1年腹主動脈假腔體積也顯著增大[（58.2±21.5）ml vs（42.5±18.5）ml， P均<0.01]，差異均有統計學意義。 　　結論：對于複雜的主動脈夾層患者行腔內脩複，術中結閤覆蓋左鎖骨下動脈、煙囪技術以及小切口的雜交技術等方法可延長錨定區，拓展主動脈夾層的腔內治療範圍，提高腔內脩複的療效，降低併髮癥的髮生，短期療效良好。
목적：탐토강내수복치료복잡성급성Stanford B형주동맥협층적단기림상료효。 　　방법：회고성분석아원2010-01지2014-06기간행강내수복치료적36례복잡성급성Stanford B형주동맥협층환자적림상자료（포괄수술정황급술후계산궤단층섭영술혈관조영수방정황），기중남성27례，녀성9례；년령41~62（평균43.7）세。 　　결과：36례환자적강내수복균획성공。22례행주동맥강내수복병복개좌쇄골하동맥개구，10례결합좌쇄골하동맥“연창”기술행주동맥강내수복，2례선실시좌경총동맥—좌쇄골하동맥인공혈관전류후재행강내수복，2례선실시우경총동맥—좌경총동맥인공혈관전류（좌경총동맥근심단결찰）후재행주동맥강내수복。내장동맥급하지동맥결혈축점회복，무내루등병발증발생。36례환자중30례환자획득수방，수방솔83.33%，수방시간1년。술후1년주동맥협층전부가강내혈전형성자10례，부분가강내혈전형성자20례。여술전비교，술후1년무론시전부가강내혈전형성자，환시부분가강내혈전형성자，흉주동맥진강체적균현저증대[（190.0±68.7）ml vs（125.3±63.4） ml화(166.2±71.8) ml vs（110.1±62.7）ml]，차이균유통계학의의（P<0.001）；이흉주동맥가강체적균현저축소[（65.0±67.4）ml vs（185.3±66.6）ml화(132.3±62.6) ml vs（224.5±72.3）ml]，차이균유통계학의의（P<0.001）。대우전부가강내혈전형성자，여술전비교，술후1년복주동맥진강체적현저증대[（55.5±12.4）ml vs（48.6±12.2）ml， P<0.01]；부분가강내혈전형성자，술후1년복주동맥가강체적야현저증대[（58.2±21.5）ml vs（42.5±18.5）ml， P균<0.01]，차이균유통계학의의。 　　결론：대우복잡적주동맥협층환자행강내수복，술중결합복개좌쇄골하동맥、연창기술이급소절구적잡교기술등방법가연장묘정구，탁전주동맥협층적강내치료범위，제고강내수복적료효，강저병발증적발생，단기료효량호。
Objective: To investigate the short term clinical efifcacy of endovascular repair for complicated acute type Stanford B aortic dissection. Methods: To retrospectively analyze the clinical data of 36 patients with complicated acute type Stanford B aortic dissection who received endovascular repair in our hospital from 2010-01 to 2014-06 including operational procedure and post-operative follow-up of CT angiography. There were 27 male and 9 female patients with the average age of 43.7 years (41-62) years. Results: Successful operations were conducted in all 36 patients. 22 patients received endovascular repair combined with covering left subclavian artery (LSA),10 received endovascular repair combined with chimney technique, 2 received endovascular repair combined with vascular prosthesis bypass from left common carotid artery to LSA, 2 received endovascular repair combined with vascular prosthesis bypass from right common carotid artery to left common carotid artery, whose proximal parts were ligated. Viscera artery and lower extremity artery supply were restored gradually. No complication of endoleak occurred. There 30/36 (83.33%) patients were followed-up for 1 year, and 10 patients developed thrombus in full false lumen and 20 developed thrombus in partial false lumen after 1 year. Compared with pre-operative values, thoracic aortic true lumen volume increased in either thrombus in full false lumen (190 ± 68.7) ml vs, (125.3 ± 63.4) ml and thrombus in partial false lumen (166.2 ± 71.8) ml vs (110.1 ± 62.7) ml,P<0.001; thoracic aortic false lumen volume decreased (65.0 ± 67.4) ml vs (185.3 ± 66.6) ml and (132.3 ± 62.6) ml vs (224.5 ± 72.3) ml,P<0.001. Compared with pre-operative values, for patients with thrombus in full false lumen, the abdominal aortic true lumen volume increased (55.5 ± 12.4) ml vs (48.6 ± 12.2) ml,P<0.01; for patients with thrombus in partial false lumen, the abdominal aortic false lumen volume also increased (58.2 ± 21.5) ml vs (42.5 ± 18.5) ml,P<0.01. Conclusion: For endovascular repair of complicated aortic dissection, covering LSA with chimney technique and hybrid operation of small incision could extend anchor zone and expand the range of endovascular repair which may improve the effect and reduce the complication for good short term effect.