杂交技术治疗Stanford B型主动脉夹层的临床疗效分析

发布时间：2018-06-04 11:39

  本文选题：主动脉夹层 + 杂交手术　； 参考：《新乡医学院》2015年硕士论文

【摘要】：背景自1999年Dake和Nienaber等在胸主动脉内置入覆膜支架成功修复胸主动脉夹层,Stanford B型主动脉夹层进入了腔内治疗的全新时代。但对于主动脉弓部病变复杂的Stanford B型主动脉夹层,单纯的胸主动脉腔内覆膜支架修复术(Thoracic endovascular aortic repair, TEVAR)已不能解决问题,因此一系列辅助性的技术手段如杂交技术、烟囱技术、开窗支架、分支支架等逐渐被临床所应用。目前应用较广的是杂交技术和“烟囱”技术。我们对本中心应用杂交技术治疗Stanford B型主动脉夹层的临床资料进行回顾性分析以研究其临床效果。目的本研究的目的在于分析杂交技术处理主动脉弓部病变复杂的Stanford B型主动脉夹层的临床效果及并发症发生情况,评估其临床应用价值。方法本研究为临床病例回顾性研究,以河南省人民医院血管外科(河南省介入治疗中心外周血管介入病区)自2011年1月至2014年12月收治的45例主动脉弓部病变复杂并实施杂交治疗的Stanford B型主动脉夹层为研究对象,收集其住院期间的临床资料(包括病历资料、术前术后主动脉CTA资料、术中DSA资料)及术后随访资料(随访时间3-46个月,收集电话随访资料或复查的主动脉CTA资料),分析患者术后及随访过程中的临床效果及并发症发生情况。结果45例患者均成功实施杂交手术,技术成功率100%。术后平均住院时间20.0天。术后住院期间共发生并发症8例(17.8%)：其中脑卒中3例(6.7%),死亡2例(4.4%),术后造影Ⅱ型内漏、并发肺部感染、并发逆行A型夹层各1例(各占2.2%),无截瘫发生。随访3-46个月,平均随访时间21个月,随访率88.9%(40/45)。随访过程中共发生并发症2例(4.8%)：其中1例患者死亡(2.4%),1例发生移植物感染(2.4%)。结论杂交技术治疗Stanford B型主动脉夹层术后及随访过程中并发症发生率低,手术效果安全可靠,但仍需警惕其部分严重并发症。
[Abstract]:Background Dake and Nienaber have entered a new era of endovascular treatment since 1999 when Dake and Nienaber successfully repaired sternoaortic dissection type B aortic dissection. However, for Stanford type B aortic dissection with complicated aortic arch lesions, Thoracic endovascular aortic repair, TEVAR) can not solve the problem. Therefore, a series of auxiliary techniques such as hybrid technique, chimney technique, etc. Fenestration stents, branching stents and so on are gradually used in clinic. At present, hybrid technology and chimney technology are widely used. We retrospectively analyzed the clinical data of Stanford B aortic dissection treated by hybridization technique. Objective to analyze the clinical effects and complications of Stanford B aortic dissection with complex aortic arch lesions by hybrid technique, and to evaluate its clinical application value. Methods this study is a retrospective study of clinical cases. From January 2011 to December 2014, 45 patients with Stanford type B aortic dissection treated by vascular surgery in Henan Provincial people's Hospital from January 2011 to December 2014 were studied. The clinical data (including medical records, preoperative and postoperative CTA data, intraoperative DSA data) and follow-up data (3-46 months) were collected. The data of telephone follow-up or CTA were collected to analyze the clinical effect and complications after operation and follow-up. Results all 45 patients were successfully performed hybrid surgery, and the technical success rate was 100%. The average postoperative hospitalization time was 20.0 days. Complications occurred in 8 cases during hospitalization: stroke occurred in 3 cases (6.7%), death in 2 cases (4.4%), postoperative type 鈪，

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