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主动脉分区在主动脉夹层腔内治疗方式选择中的意义

, PP. 2086-2090

Keywords: 胸主动脉分区,主动脉夹层,腔内治疗,杂交技术

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Abstract:

目的探讨主动脉分区在不同类型主动脉夹层腔内治疗方式选择中的意义。方法2009年1月至2015年1月成都军区总医院心血管外科共对208例诊断为主动脉夹层的患者完成了经股动脉腔内支架植入术,其中42例夹层破口位于主动脉弓或升主动脉的患者先建立了头臂动脉间或升主动脉至头臂动脉的血管旁路,然后再完成腔内支架植入(杂交技术)。按照头臂血管分支与主动脉之间的关系将胸主动脉依次分为-1、0、1、2、3、4区共6个区域。根据夹层破口所在的区域不同,采用个体化的腔内治疗方式,对破口位于升主动脉或降主动脉(-1区、3区、4区)且不累及重要主动脉分支的夹层患者采用单纯腔内支架隔绝术,对累及重要头臂分支的夹层患者,先建立头臂动脉之间的血管旁路或升主动脉与头臂动脉间的旁路,再进行腔内支架隔绝术。结果无围术期死亡及严重并发症的发生,术后复查支架及旁路血管内血流通畅。1例患者出现Ⅰ型内漏,1例患者出现Ⅱ型内漏,1例患者术后1个月时支架远端主动脉内膜再次发生破裂,重新植入1枚支架后痊愈。其余患者术后3个月至1年复查时情况良好,无明显的胸痛、气紧等症状,支架及旁路内血流通畅,无支架移位及内漏发生。所有患者于术后3个月及术后1年常规复查,此后每年随访1次,20例患者术后1年失访。结论按主动脉分区对不同类型主动脉夹层的腔内治疗进行个体化方案选择,有利于简化手术方式,拓宽血管腔内治疗的适应证。

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