分支血管灌注不良分型在主动脉夹层腔内修复术中的应用及分析

发布时间：2018-05-02 11:37

本文选题：主动脉夹层 + 腔内治疗　；参考：《北京大学学报(医学版)》2017年06期

【摘要】：目的:分析Stanford B型主动脉夹层累及腹腔四分支血管灌注不良情况,探讨腔内修复术对腹腔四分支血管灌注的影响。方法:回顾性分析2015年9月至2016年3月收治并确诊为Stanford B型主动脉夹层的患者32例,男28例,平均年龄(52.9±9.6)岁(32~70岁),收集患者的临床影像学资料及随访结果。基于Nagamine分支血管灌注不良细化分型,分析术前和术后主动脉CT血管造影(computed tomography angiography,CTA)影像资料,对灌注不良的腹腔四分支血管(腹腔干动脉、肠系膜上动脉、左肾动脉及右肾动脉)进行分类和统计学分析。结果:32例患者腹腔四分支血管共128支,其中86支分支血管(67.2%)属于Ⅰ类灌注不良,Ⅰ-a亚型占60.9%(78/128),Ⅰ-b亚型占0.8%(1/128),Ⅰ-c亚型占5.5%(7/128);14支分支血管(10.9%)属于Ⅱ类灌注不良,Ⅱ-a亚型占3.9%(5/128),Ⅱ-b-1亚型占3.9%(5/128),Ⅱ-b-2亚型占3.1%(4/128);16支分支血管(12.5%)属于Ⅲ类灌注不良,均为Ⅲ-a亚型(无Ⅲ-b和Ⅲ-c亚型);其余12支分支血管未受累。32例患者均完成了胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR),手术成功率100%,术后平均随访4个月。术后复查CTA显示,14支(10.9%)属于"高危"灌注不良亚型(Ⅰ-b、Ⅰ-c和Ⅱ-b-2亚型)的分支血管中,13支(92.9%)灌注不良明显改善,其余1支的灌注亚型由Ⅰ-b转归为Ⅰ-c。结论:Stanford B型主动脉夹层累及腹腔四分支血管灌注明显受损所占的比例较低,TEVAR能有效改善分支血管的灌注不良状态,推广Nagamine分支血管灌注不良细化分型,对判断夹层受累分支血管灌注不良状况及指导是否分支血管腔内重建意义重大。
[Abstract]:Objective: to analyze the effect of four branches of Stanford B aortic dissection involving intraperitoneal instillation, and to explore the effect of endovascular repair on intraperitoneal four branch vascular perfusion. Methods: a retrospective analysis of 32 patients with Stanford B aortic dissection from September 2015 to March 2016 and 28 male patients with an average age of (52.9 + 9.6) years (32~70) The clinical imaging data and follow-up results of the patients were collected. Based on the Nagamine branch perfusion poor classification, the preoperative and postoperative aortic CT angiography (computed tomography angiography, CTA) images were analyzed, and the four branches of abdominal artery, superior mesenteric artery, left renal artery and right kidney with poor perfusion were analyzed. Results: there were 128 branches of four branches in the abdominal cavity of 32 patients, of which 86 branch vessels (67.2%) belonged to type I poor perfusion, I -a subtype accounted for 60.9% (78/128), I -b subtype accounted for 0.8% (1/128), I -c subtype 5.5% (7/128); 14 branch vessels (10.9%) belonged to class II perfusion poor, II -a subtype 3.9% (5/128), The subtype of II -b-1 accounted for 3.9% (5/128), the subtype of II -b-2 accounted for 3.1% (4/128), and 16 branch vessels (12.5%) belonged to class III poor perfusion, all of which were III -a subtype (no III -b and III -c subtype). The remaining 12 branches of the blood vessels were not involved in the thoracic aorta endovascular repair (thoracic endovascular aortic repair,), and the operation success rate was 100%. The operation rate was 100%. The operation rate was performed. The operation rate was 100%. The operation rate was successful. The operation rate was 100%, the operation rate was performed. The operation rate was 100%. The operation rate was successful. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was successful. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was 100%. The operation rate was successful. The operation rate was 100%. The operation rate was 100%, the operation rate was 100%, the operation rate was performed. After an average follow-up of 4 months, the postoperative review of CTA showed that 14 (10.9%) belonged to the branch vessels of "high risk" subtype of perfusion (I -b, I -c and II -b-2 subtype), 13 (92.9%) instillation significantly improved, and the other 1 subtypes were transferred from I -b to I conclusion: Stanford B type aortic dissection involved four branch vascular perfusion in the abdominal cavity. The proportion of the loss is low. TEVAR can effectively improve the poor perfusion state of the branch vessels and popularize the poor classification of Nagamine branch perfusion. It is of great significance to judge the poor perfusion of the interlayer and to guide the reconstruction of the intravascular endovascular reconstruction.

【作者单位】：首都医科大学附属北京安贞医院介入诊疗科北京市心肺血管疾病研究所;
【分类号】：R654.3

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