腔内修复术治疗45例Stanford B型主动脉夹层的中期随访研究

发布时间：2018-03-21 20:36

  本文选题：Stanford　切入点：B型主动脉夹层　出处：《郑州大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的对在我院45例Stanford B型主动脉夹层患者进行腔内隔绝术(EVAR)治疗的的中期疗效随访,临床特征及诊治过程进行回顾性分析,并对其中期随访结果进行总结,从而评价腔内隔绝术治疗Stanford B型主动脉夹层的中期疗效和安全性。方法收集从2009年1月至2013年12月到我院接受治疗的Stanford B型主动脉夹层腔内治疗病人的病例资料,进行回顾性分析和总结。共45例病人,男性35例,女性10例,平均50.6±11.2岁,最大年龄79岁,最小24岁。其中,合并症有:3例夹层患者合并有破裂出血,4例患者合并有腹腔脏器急性缺血,5例患者同时合并下肢严重缺血,1例为急性主动脉的透壁性溃疡。按疾病病程分:38例属于急性期,7例患者属于亚急性期。本研究通过对患者术前的资料、手术过程中的造影(digital subtraction angiography,DSA)资料以及术后门诊检查结果及电话的随访内容进行综合分析,观察主动脉夹层患者发病急性期所发生的解剖学数据变化、手术经过,并在后期所进行的随访中观察患者是否发生内漏、有无支架的移位和是否发生人工血管内支架塌陷等影响患者生存质量的术后并发症,根据随访结果和影像学资料评估患者临床转归和动脉重塑情况。分析导致主动脉夹层患者急性期发生死亡的常见高危因素。并在此基础上对选择进行干预的方式及时机,与此同时,我们试图对导致腔内隔绝术后Stanford B型主动脉夹层向stanford A型主动脉夹层转化的原因进行探究,随访观察腔内修复术后可能发生的并发症并寻找预防和处理的方法。结果本研究术中共植入主动脉覆膜支架51枚(选用进口支架43枚,选用国产支架8枚),其中3例置入2枚支架,2例植入三枚支架。没有术中发生死亡或因病情需要转为开胸手术的患者。所有的患者随访时间截止到2013年12月,术后30天内共死亡2例,失访2例,随访41例。平均随访31.3±23.7月。随访过程中有7例患者发生Ⅰ型内漏,其中有2例为内漏量大进行短支架(Cuff)植入治疗,其余5例均表现为少量内漏,未行处理,在随访过程中2例内漏自行消失。腔内修复术后假腔的转归主要有以下的类型:近端假腔消失(14/45,31.1%)、假腔内血栓形成机化(31/45,68.9%)、夹层的远端假腔仍有血流(27/45,60%)。结论作为治疗Stanford B型主动脉夹层的一种安全并且行之有效的治疗选择,腔内隔绝术有令人满意的中期治疗效果,实施胸主动脉腔内隔绝术的最佳的时机是亚急性期,在条件满足的情况下要尽可能的避免在急性期进行腔内修复术,术后进行定期随访对提高患者的生存质量具有重大意义。
[Abstract]:Objective to analyze the middle term follow-up, clinical characteristics, diagnosis and treatment of 45 patients with Stanford B aortic dissection treated by endovascular exclusion, and to sum up the results of middle term follow-up. Objective to evaluate the efficacy and safety of endovascular exclusion in the treatment of Stanford B aortic dissection. Methods from January 2009 to December 2013, the data of patients with Stanford B aortic dissection treated in our hospital were collected. There were 45 patients, 35 males and 10 females, with an average age of 50.6 卤11.2 years. The maximum age was 79 years and the youngest was 24 years old. There were 3 cases of dissection complicated with rupture and hemorrhage 4 cases with acute ischemia of abdominal viscera 5 cases with severe ischemia of lower extremity 1 case with transmural ulcer of acute aorta. According to the course of disease 38 cases were classified as acute aortic ulcer. In the acute phase, 7 patients belong to subacute stage. The anatomic data of patients with aortic dissection during the acute stage of aortic dissection were observed by analyzing the data of digital subtraction angiography during operation, the results of outpatient examination and telephone follow-up. The postoperative complications such as internal leakage, stent displacement and stent collapse in the later period of follow-up were observed, which affected the quality of life of the patients. According to the follow-up results and imaging data, the clinical outcome and arterial remodeling were evaluated. The common risk factors leading to death in acute stage of aortic dissection were analyzed. At the same time, we try to explore the causes of the transformation of Stanford B aortic dissection to stanford A aortic dissection after endovascular exclusion. The possible complications after endovascular repair were observed and the methods of prevention and treatment were explored. Results 51 aortic stents (43 imported stents) were implanted in this study. 8 domestic stents were selected, of which 3 cases were implanted with 2 stents and 2 cases were implanted with 3 stents. There were no patients who died during operation or had to undergo thoracotomy because of their condition. All patients were followed up until December 2013. A total of 2 cases died, 2 cases lost their visits and 41 cases were followed-up within 30 days after operation. The average follow-up was 31.3 卤23.7 months. During the follow-up, 7 cases had type 鈪，

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