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目的探讨累及主动脉弓部的Stanford B型主动脉夹层的各种腔内治疗方法的优缺点。方法回顾性分析2005年1月至2015年12月安徽医科大学附属省立医院收治的42例累及主动脉弓的Stanford B型主动脉夹层的临床资料。所有患者均经腔内治疗,根据夹层形态不同,分别应用腔内直接封堵左锁骨下动脉(left subclavian artery,LSA)、“烟囱”技术、移植物开槽、颈部血管旁路手术重建主动脉弓部分支血管。结果 42例患者中,腔内直接封堵LSA32例,发生Ⅰ型内漏3例,Ⅱ型内漏6例,2例通过LSA栓塞好转。术后出现1例下肢截瘫,1例盗血综合征,2例上肢缺血,均行保守治疗后好转。4例通过“烟囱”技术重建LSA,2例发生Ⅰ型内漏。4例通过“开窗”技术保留LSA。2例通过颈部血管旁路重建左颈总动脉及锁骨下动脉。围手术期无死亡病例。中长期随访中,所有分支动脉支架均保持通畅,大部分内漏逐渐消失,3例术后持续存在内漏,但瘤体直径无变化。结论对累及主动脉弓部的Stanford B型主动脉夹层,在严格做好术前评估、选择合适术式的情况下,腔内治疗是安全有效的。
Objective To investigate the advantages and disadvantages of various endovascular treatments for Stanford type B aortic dissection involving the aortic arch. Methods The clinical data of 42 patients with Stanford type B aortic dissection involving the aortic arch from January 2005 to December 2015 in Provincial Hospital of Anhui Medical University were retrospectively analyzed. All patients underwent endovascular treatment. According to the different sandwich types, the left subclavian artery (LSA), “chimney” technique, graft incision and neck bypass surgery Reconstruction of the aortic arch branch of the blood vessels. Results Of the 42 patients, 32 cases of LSA were occluded in the lumen directly, 3 cases of type Ⅰ endoleak, 6 cases of type Ⅱ endoleak and 2 cases of LSA embolization were improved. One case had paraplegia of lower limbs, one case of steal syndrome, and two cases of upper limb ischemia after operation, all of which were improved after conservative treatment. In 4 cases, LSA was reconstructed by the “Chimney” technique, and type I leakage occurred in 2 cases. In 4 cases, the LSA was preserved through “fenestration ” technique. In 2 cases, the left common carotid artery and subclavian artery were reconstructed through the neck bypass. Perioperative death cases. In the medium and long term follow-up, all branch artery stents remained unobstructed, most of the internal leakage gradually disappeared, and 3 patients continued to have internal leakage after operation, but the diameter of the tumor did not change. Conclusions Endovascular treatment is safe and effective for the Stanford type B aortic dissection involving the aortic arch, with rigorous preoperative evaluation and appropriate surgical procedures.