目的评价用主动脉夹层动脉瘤腔内隔绝术治疗StanfordB型主动脉夹层动脉瘤的近、中期临床疗效。方法2002年5月至2006年9月,行主动脉腔内隔绝术治疗B型主动脉夹层46例。其中男36例,女10例;年龄62±18岁。46例均经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后造影检查证实疗效,术后随访1~52个月,平均17±16个月,分析其临床特点及疗效。结果住院期间及随访30d内无患者死亡;发生主动脉腔内隔绝术后综合征11例;2例患者左锁骨下动脉被封闭;5例发生内漏,术后3个月时其中4例内漏自行封闭。随访3个月时,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后半年1例发生截瘫,原因不明。术后1年1例出现迟发性内漏;1例升主动脉发现夹层,未行外科手术。随访期间3例死亡,4年生存率89.3%。结论用主动脉夹层动脉瘤腔内隔绝术治疗B型主动脉夹层动脉瘤的近、中期疗效满意。 Objective To evaluate the clinical efficacy of endovascular graft exclusion for aortic dissection in the treatment of Stanford type B aortic dissection aneurysm. Methods From May 2002 to September 2006, 46 cases of type B aortic dissection were treated with endovascular aortic dissection. There were 36 males and 10 females, aged 62 ± 18 years old. Forty-six cases were treated by femoral artery dissection and stent placement to block thoracic aortic rupture. Postoperative angiography was performed to confirm the curative effect. The patients were followed up for 1 to 52 months with an average of 17 ± 16 months. Efficacy. Results No patient died during hospitalization and within 30 days of follow-up. Eleven patients developed aortic endovascular isolation syndrome, 2 patients had left subclavian artery closed, 5 patients developed endoleak, and 4 patients within 3 months after operation Leak self-enclosed. At 3 months of follow-up, all patients had a ruptured endometrium, an enlarged true lumen of the descending thoracic aorta and abdominal aorta, thrombosis in the foramen, and a normal position and shape of the stent. One case of paraplegia occurred after six months, the reason is unknown. One case had delayed leakage after one year; one case had dissection found in the ascending aorta without surgery. Three patients died during follow-up, and the 4-year survival rate was 89.3%. Conclusions Endovascular graft exclusion with aortic dissecting aneurysm in type B aortic dissection has satisfactory results in the near and the medium term.