[1]舒畅,汪忠镐①,李全明,等.复杂主动脉病变的腔内血管外科治疗[J].中国微创外科杂志,2007,07(7):698-600.
　Shu Chang*,Wang Zhonggao,Li Mingquan*,et al.Endovascular therapy for complicated aortic diseases[J].Chinese Journal of Minimally Invasive Surgery,2007,07(7):698-600.
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复杂主动脉病变的腔内血管外科治疗()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
07
期数:
2007年7期
页码:
698-600
栏目:
出版日期:
2007-07-20

文章信息/Info

Title:
Endovascular therapy for complicated aortic diseases
作者:
舒畅; 汪忠镐①; 李全明; 姜晓华; 宫毅; 黎明
中南大学湘雅第二医院血管外科, 长沙410011
Author(s):
Shu Chang*;  Wang Zhonggao;  Li Mingquan*;  et al.
*Department of Vascular Surgery, Second Hospital of Xiangya Medical College of Central South University, Changsha 410011, China
关键词:
主动脉病变; 腔内血管治疗; 内漏
Keywords:
Aortic disease; Endovascular therapy; Endoleak
分类号:
R654.3;R543.1
文献标志码:
A
摘要:
目的探讨复杂主动脉病变的腔内血管外科治疗方法。方法对21例合并有内脏动脉缺血等复杂的主动脉病变，双球管定位下经锁骨上动脉到股动脉交换导丝以确保真腔内植入带膜支架，对真腔完全被假腔压闭的患者采取真腔内加压推进以通过导丝，用超长带膜支架来封堵大破口治疗夹层合并巨大假性动脉瘤形成，对夹层合并腹主动脉瘤患者采取血管腔内技术联合开腹手术等方法。结果术后内漏3例，其中2例7 d后停止，1例漏血持续存在。3例主动脉创伤术后完全康复，余18例复杂主动脉夹层术后即时造影示瘘口已被完整覆盖，假腔无血漏入，内脏动脉等恢复真腔供血。18例中6例合并肠管缺血，3例合并肾动脉缺血，3例肠管缺血、肾动脉缺血，2例腹主动脉真腔完全被假腔压迫，以及2例合并下肢缺血术后均逐渐恢复，无脏器及肢体缺血坏死发生。2例合并腹主动脉瘤夹层行支架型人工血管封闭夹层破口后行开腹手术切除腹主动脉瘤、人工血管置换。16例随访5~36个月,平均223月，1例内漏持续存在，但假腔未继续加大，其余患者存活良好。结论对复杂的主动脉病变的治疗，通过对腔内血管外科技术进行改进，并适当结合传统手术方法，使某些过去被认为不能够治疗的复杂主动脉病变可得以成功治疗。
Abstract:
ObjectiveTo explore methods of endovascular therapy for complicated aortic diseases.MethodsA total of 21 cases of complicated aortic diseases was treated by endovascular therapy using improved endoluminal technique. Under the positioning of angiography, a guide wire was passed from the subclavian to the femoral artery to ensure the stent implantation in the true lumen. In case of the true lumen completely compressed by the false one, the guide wire was advanced under pressure. An extralong stentgraft was used to treat giant dissecting aneurysms. Endoluminal technique combined with open surgery was employed in patients with dissecting aneurysm accompanying abdominal aortic aneurysm.ResultsEndoleak happened in 3 cases after the stentgraft deployment. The endoleak spontaneously stopped at 7 days after operation in 3 cases and remained in 1. Among the 21 cases, 3 cases of aortic trauma completely recovered postoperatively, while in other 18 cases, angiography showed that all the disease area were sealed completely and the visceral arteries recovered with blood supply via the true lumen. Of the 18 cases, there were 6 cases of severe ischemia of the mesenteric artery, 3 cases of ischemia of the renal artery, 3 cases of renal artery ischemia and superior mesenteric artery ischemia, 2 cases of the true lumen completely compressed by the false lumen, and 2 cases of ischemia of lower limbs, all of which were gradually recovered postoperatively, without ischemia of organs or extremities. Two cases combined with abdominal aortic aneurysm were given open surgery after the aortic dissection had been treated by stentgraft. Followup examinations were conducted in 16 cases for 5~36 months (mean,22.3 months). The endoleak remained in 1 case, but with no enlargement of the false lumen. The other cases survived well.ConclusionsIn the management of complicated aortic diseases, improved endoluminal technique and combination with open surgery will be able to treat some complicated cases seemed to be untreatable before.

参考文献/References:

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备注/Memo

备注/Memo:
①（首都医科大学宣武医院血管外科研究所, 北京100053）
更新日期/Last Update: 2013-12-09