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目的探讨腔内修复术治疗合并严重并发症的Stanford B型主动脉夹层的安全性和有效性。方法 2003年1月-2009年12月,收治60例合并严重并发症的Stanford B型主动脉夹层患者。男39例,女21例;年龄34～71岁,平均43.7岁。合并大量血胸27例,截瘫1例,急性肾衰竭7例,腹腔干严重缺血10例,肠系膜上动脉严重缺血10例,下肢严重缺血5例。患者均行带膜支架腔内修复术及相关辅助治疗,术中成功植入64个带膜支架。结果术后患者均存活并获随访,随访时间3～86个月。术前合并大量血胸者胸腔积血在术后28d～3个月完全消失;合并肾衰竭患者肾功能在术后1～9d恢复正常;合并内脏动脉和下肢严重缺血患者术后1～14d逐渐恢复血供;截瘫患者自术后4h下肢肌力开始恢复。术后主动脉CT血管造影显示真腔已恢复,假腔内血栓形成。结论腔内修复术治疗合并严重并发症的StanfordB型主动脉夹层安全、有效。
Objective To investigate the safety and efficacy of endovascular repair in the treatment of Stanford type B aortic dissection with severe complications. Methods From January 2003 to December 2009, 60 patients with Stanford type B aortic dissection with serious complications were treated. 39 males and 21 females; aged 34 to 71 years, mean 43.7 years. There were 27 cases with large hemothorax, paraplegia in 1 case, acute renal failure in 7 cases, celiac severe ischemia in 10 cases, superior mesenteric artery ischemia in 10 cases and lower extremity ischemia in 5 cases. Patients underwent endovascular stent-graft repair and related adjuvant therapy. Sixty-four stent-covered stents were implanted intraoperatively. Results All patients survived and were followed up for 3 ~ 86 months. Preoperative hemothorax with plethora of hemothorax patients completely disappeared 28d ~ 3 months after operation; renal function in patients with renal failure returned to normal after 1 ~ 9d; patients with severe visceral arteries and lower limb ischemia 1 ~ 14d Gradually restore blood supply; paraplegia patients began to recover after 4h lower limb muscle strength. Postoperative aortic CT angiography showed true cavity has been restored, false lumen thrombosis. Conclusions Endovascular repair is safe and effective in the treatment of Stanford type B aortic dissection with severe complications.