摘要
目的探讨腔内修复术治疗Stanford B型主动脉夹层围手术期并发症发生原因及预防、处理措施。方法回顾2013年7月—2014年11月在我院血管外科行腔内修复术的急性Stanford B型主动脉夹层52例的临床资料,分析其围手术期并发症发生原因及相关预防、处理措施。结果本组52例均经股动脉入路按常规要求行主动脉腔内修复术,共置入54枚覆膜支架。围手术期发生并发症16例（30.8%）。术前出现股动脉栓塞1例,先行右股动脉切开取栓后再行覆膜支架置入术,术后右下肢动脉通畅。术中即刻内漏8例,其中3例通过球囊扩张,增加支架与血管壁的贴附力,内漏消失,5例严密观察,术后3-12个月随访内漏消失;出现支架后移2例,于近端加用短支架确保治疗效果,术后随访6个月未出现支架移位及内漏等;支架误入假腔1例,通过大球囊扩张破膜使支架重回真腔,术后10 d、3个月复查支架位于真腔。术后30 d内发生缺血性脑卒中2例,予对症治疗,术后3个月生活可自理;上肢缺血2例,因不影响生活质量未干预治疗。结论腔内修复术治疗Stanford B型主动脉夹层需重视围手术期相关并发症的预防与处理;对并发症发生机制深入研究、介入操作技术进步和医疗器械改进,可减少或避免其围手术期并发症的发生。
Objective To analyze the causes, prevention and treatment of the perioperative complications of Stanford B type dissection during endovascular treatment. Methods During July 2013 and November 2014, statistical analysis of 52 cases of Stanford B type dissection with endovascular repair, and the causes, prevention and treatment of perioperative complications were analyzed. Results 52 cases underwent the endovascular treatment and 54 coated stents were inserted. Preoperative complications occurred in 16 cases （30.8%）. One case of lower extremity arterial embolization occurred before the stent placement with a stent graft and the first right lower limb artery was cut open and the thrombus was taken out. 8 cases of immediate internal leakage occurred; through balloon expansion, increased support and attached with a force of blood vessel walls in 3 cases, 5 cases of close observation, and leakage disappeared in follow-up of 3-12 months. 2 cases of intraoperative stent shift occurred and the proximal stent was added to ensure effective treatment. The 6-month follow-up did not show any shift and leakage. One stent strayed into the false lumen and was moved back to true lumen, through a big balloon expansion rupture in the bracket and the stent was also located in the true lumen for 10 d and 3 months postoperatively. On 30 d postoperative, 2 cases of stroke occurred and after the symptomatic treatment, the patients were on their own in postoperative 3 months. Upper limb occurred in 2 cases but did not affect the quality of life and therefore no intervention was given. Conclusion The prevention and treatment of the preoperative complications of Stanford B type dissection during endovascular treatment should be emphasized. Further study of mechanisms of complications, interventional operational technology and the improvement of medical equipment can help to reduce or avoid the incidence of preoperative complications.
出处
《临床误诊误治》
2016年第5期68-71,共4页
Clinical Misdiagnosis & Mistherapy
关键词
动脉瘤
夹层
血管成形术
围手术期
并发症
Aneurysm, dissecting
Angioplasty
Perioperative period
Complication
