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1、覆膜支架腔内隔绝术治疗急性主动脉夹层6例诊疗体会黄志军穆向明孙鹏飞刘高巧刘艳红(盐城市第一人民医院普外科224001)【摘要】目的：探讨覆膜支架腔内隔绝术治疗StandfordB型主动脉夹层的技术及疗效。方法：对6例主动脉夹层进行分析，6例患者均行股动脉穿刺插管至升主动脉造影，了解主动脉真假腔、夹层裂口及其与重要血管分支位置关系。切开股动脉置入覆膜支架，封堵原破口，置入后即刻造影检查。观察真假腔血流变化、主动脉分支供血的情况。结果：6例患者支架置入定位准确，术后即刻造影显示真腔明显扩大显影良好，近端裂口未见内漏，原假腔未再见显影或少量
2、远端裂口返流影。无截瘫及瘤体破裂等严重并发症。所有患者术后随访均恢复良好。结论：覆膜支架腔内隔绝术治疗B型主动脉夹层具有简捷、微创、并发症少、术后恢复快等优点，但远期效果有待进一步观察。【关键词】主动脉夹层；覆膜支架；腔内隔绝术【中图分类号】R2【文献标号】A【文章编号】1671-8725(2014)ll-0016-02Theexperienceofendovascularexclusionon6casesofacuteaorticdissectionbystent・graftsHUANGZhi-jun,MUXiang・ming,SU
3、NPeng-fei,LIUYan-hong,LiuGao-qiao(GeneralSurgeryCenter,Yancheng1stpeopelHospital,JiangSu,China,224001)abstract:Objective:ToinvestigatethetechniquesandeffectivenessofendovascularrepairfortreatingStanfordtypeBthoracicaorticdissection.Methods:Treatmentof6casesofaorticdisse
4、ctionwasretrospectivelyanalyzed.6patientswereperformedfemoralarterypunctureintubationtotheascendingaortaangiography,understandingtheaortictrueandfalselumen,interlayerfissureanditsrelationshipwithimportantvascularbranchlocation.wecutthearteryandputinstent-grafttoblockthe
5、primarycrevasse,andthenimmediatelygivenanangiographytoobservethetrueandfalsecavitybloodflowchanges,aorticbranchbloodsupply.Results:withaccuratestentimplantation,6patientsbyimmediateangiographyshowedasign讦icantincreaseinthetruelumen,noleakintheproximaltear,nocontrastagen
6、tsdevelopmentinthefalselumenorasmallamountofdistaltearregurgitation.Noparaplegiaandseriouscomplicationssuchastumorsbursting.AIIpatientswithpostoperativefollow-upwererecoveredwell.Conclusion:thetreatmentofStanfordtypeBaorticdissectionbystent-graftissimple,minimallyinvasi
7、ve,lesscomplicationsandfastrecovery,buttheIong-termeffectremainstobeseen.keywords:Acuteaorticdissection,Stent・graft,Endovascularexclusion主动脉夹层(aorticdissection,AD)是一种严重威胁生命的主动脉疾病，年自然发病率高达万分之一⑴，以发病急、进展快、病死率高为主要特点。近年来，随着数字减影血管造影术(DSA)和CT血管造影(CTA)的发展，使AD的诊断与治疗日益准确而快捷。腔内隔绝术
8、(endovascularexclusion,EVE)的发展极大的丰富了AD的治疗，不仅能减轻手术的创伤，还能增加手术的安全性，使得众多的StandfordB型AD患者得到及吋安全有效的治疗。近年来我院共收治急性Stan
