封堵左锁骨下动脉修复Stanford B型主动脉夹层40例分析.docVIP

封堵左锁骨下动脉修复Stanford B型主动脉夹层40例分析 　　摘要：目的 分析直接封堵左锁骨下动脉修复锚定区15 mm的Stanford B型胸主动脉夹层的临床治疗效果。方法 回顾性分析2009年1月～2011年1月在泸州医学院附属医院急诊医学部采用直接封堵左锁骨下动脉修复40例锚定区15 mm的Stanford B型胸主动脉夹层患者的临床疗效。结果 40例患者中39例成功植入覆膜支架，准确覆盖夹层破口及左锁骨下动脉开口，1例因主动脉迂曲无法植入，平均手术时间（52.4±6.8）min，平均住院时间（5.8±1.8）d，术后随访48个月，无患者死亡，术后并发症包括：支架移位1例；左上肢缺血2例，其余患者效果良好。结论 直接封堵左锁骨下动脉修复锚定区15 mm的Stanford B型胸主动脉夹层具有操作简便，手术时间短，并发症少，术后恢复快的优势，但必须根据willis环及左椎动脉情况选择术式。 　　关键词：主动脉夹层；支架；腔内修复 　　Thoracic Endovascular Repair by Covering the Left Subclavian Artery on Stanford B Type Thoracic Aortic Dissection：An analysis of 40 cases 　　YANG Fan，DENG Lu 　　（Department of Emergency Medicine，The Affiliated Hospital of Luzhou Medical College，Luzhou 646000，Sichuan，China） 　　Abstract：Objective To investigate the clinical effect of covering the left subclavian artery directly on Stanford B type Thoracic Aortic Dissection which landing zone less than 15mm. Methods We retrospectively analyzed covering the left subclavian artery directly in treatment of 40 patients with Stanford B type aortic dissection which landing zone less than 15mm in the Affiliated Hospital of LuZhou medical college from January 2009 to January 2011. Results The stent-graft was successfully performed in 10 patients，and 1 patientsfailed by the descending aorta circuity .The mean operative time was（52.4±6.8）minutes and the the mean inpatient time was（5.8±1.8）days. All patients were followed up in 48 months postoperatively，no death occurred.1 case had stent migration and the left upper limb ischemia was noted in 2 patients，no major complications occurred in others patients.Conclusion Covering the left subclavian artery directly in treatment of Stanford B type Thoracic Aortic Dissection which landing zone less than 15mm is definitely effective，shorten the operation time and has less complications，fast recovery，yet it is requested to choice the operation manner based on the circumstances of willis cycle and left vertebral artery. 　　Key words：Aortic dissection ；Stent ；Endova