| 张艮龙,于智勇,赵得银,等.烟囱植入、体外开窗及直接封堵法处理斯坦福B型胸主动脉夹层腔内修复胸主动脉夹层腔内修复术中累及弓上第3分支动脉19例[J].安徽医药,2019,23(9):1848-1851. |
| 烟囱植入、体外开窗及直接封堵法处理斯坦福B型胸主动脉夹层腔内修复胸主动脉夹层腔内修复术中累及弓上第3分支动脉19例 |
| The treatment of Aortic arch 3rd vessel branch in Z1，2 anchored stent endovascular repair Stanford type B aortic dissection |
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| DOI：10.3969/j.issn.1009-6469.2019.09.039 |
| 中文关键词: 主动脉夹层 覆膜支架植入 左锁骨下动脉 烟囱技术 |
| 英文关键词: Aortic dissection Covered stent implantation Left subclavian artery Chimneytechnique |
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| 摘要点击次数: 2017 |
| 全文下载次数: 593 |
| 中文摘要: |
| 目的 探讨胸主动脉腔内修复术(TEVAR)治疗斯坦福(Stanford)B型胸主动脉夹层过程中累及弓上血管分支的处理方法。方法 回顾性分析2014年9月至2018年5月宿州市立医院收治的斯坦福B型胸主动脉夹层病人19例，均为胸主动脉撕裂累及弓上第3分支动脉(左锁骨下动脉)和(或)锚定区不足(夹层近侧破口距弓上第3分支动脉开口＜15 mm)，TEVAR术中覆膜支架Z1、Z2锚定覆盖弓上第3分支动脉或同时覆盖弓上第2分支动脉(左颈总动脉)。弓上第3分支动脉分别用烟囱植入、体外开窗开通和直接封堵处置。结果 19例TEVAR术中弓上第3分支动脉均处理成功，其中15例采用烟囱植入，2例采用体外开窗，2例分别采用直接封堵或部分封堵。随访2~24个月，15例采用烟囱植入处理的支架通畅率为100％。所有病人术后均无特殊并发症，均存活。经过1、3、6个月，1、2年的CT血管造影(CTA)复查，胸主夹层假腔内血栓机化，血管真腔直径扩大，无狭窄或闭塞。结论 TEVAR固定覆膜支架在Z1和Z2修复斯坦福B型胸主动脉夹层手术中，对于弓上第3分支动脉处理，需根据病人具体情况，定制个体化方法，效果满意。 |
| 英文摘要: |
| Objective To explore the treatment methods of thoracic aortic endovascular repair (TEVAR) in Stanford B type aortic dissection with Z1，2 anchor stents and its efficacy.Methods Retrospective analysis of 19 clinical and radiographic diagnoses of aortic tear involving Aortic arch 3rdvessel branch (left subclavian artery) and (or) lack of anchor zone (first break left subclavian artery opening ＜15 mm) Patients with Stanford type B thoracic aortic dissection were assessed by CTA and DSA.TEVAR intraoperative stent Z1，2 anchored to cover the 3rd branch or 2nd，3rdvessel branch (left common carotid artery) on the arch，using the "chimney" technology implantation，external pre-open window，direct coverage to deal with the 3rd branch.Results Nineteen cases of thoracic aorta covered stents were successfully treated.Among them，15 cases of the left subclavian artery “chimney” were implanted successfully，2 cases were pre-opened in vitro，and 1 case was directly or partially blocked.Followed up for 2-24 months，15 patients with left subclavian artery "chimney" stent patency rate was 100%.No postoperative complications occurred and all survived.After l，3，6 months，1，2 years to be perfomled CTA review，showing the dissection of false lumen reduced，true lumen diameter expansion，without stenosis or occlusion.Conclusion The treatment of Aortic arch 3rd vessel branch in Z1，2 anchored stent endovascular repair Stanford type B aortic dissection，according to the specific circumstances of patients，custom personalized methods，the effect is satisfactory. |
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