目的评价覆膜支架腔内治疗急性胸主动脉综合征的有效性和安全性。方法 2001年5月至2005年12月应用覆膜支架治疗57例急性胸主动脉综合征患者,其中急性主动脉 B 型夹层45例,穿透性粥样硬化性溃疡(PAU)或假性动脉瘤9例,创伤性胸主动脉瘤3例。建立数据库,分析其临床特点、疗效及随访结果。结果 57例患者覆膜支架置入技术成功率100%。5例有近端内漏,1例术中出现升主动脉夹层,未予特殊处理,随访结果良好;1例术后7天出现升主动脉夹层并发心包填塞死亡。5例 PAU 或主动脉夹层合并冠心病患者,在应用覆膜支架成功完全封闭破口后立即行冠状动脉介入治疗成功。1例出现术后一过性双下肢无力,经静脉滴注山莨菪碱和甘露醇2天后痊愈。1例支架覆盖左锁骨下动脉开口导致左椎动脉缺血,嗜睡2天后自行好转。术后重症监护病房时间1～8(平均3.5)天,术后平均住院10天。术后30天内死亡2例,1例死于升主动脉夹层破裂,1例死于急性肾衰竭。术后30天内死亡率3.5%。术后平均随访(25.3±13.1)(13～55)个月。1例于术后3个月死于大咯血,1例死因不明。1例因近端内漏行二次腔内修复术。5例患者因降主动脉覆膜支架远端再发现破口,行二次腔内修复术。术后截瘫发生率为0,无支架移位、狭窄等并发症。术后住院及随访期内总死亡率为7.0%。与传统手术相比,腔内治疗急性胸主动脉综合征具有创伤小、严重并发症少、住院时间较短的优势。结论覆膜支架是治疗急性胸主动脉综合征优良且有效的方法,也可用于外科手术高风险患者,近中期随访结果良好,远期结果有待于进一步随访。 Objective To evaluate the efficacy and safety of stent-graft for the treatment of acute thoracic aortic syndrome. Methods From May 2001 to December 2005, 57 patients with acute thoracic aortic syndrome were treated with stent-graft, including 45 cases of acute aortic B-type dissection, penetrating atherosclerotic ulcer (PAU) or pseudo-arteries 9 cases of tumor, 3 cases of traumatic thoracic aortic aneurysm. Establish a database to analyze its clinical features, efficacy and follow-up results. Results The success rate of stent implantation in 57 patients was 100%. 5 patients had proximal endoleak and 1 patient had ascending aortic dissection without any special treatment. The follow-up results were good. One patient had ascending aortic dissection and died of pericardial tamponade 7 days after operation. In 5 patients with PAU or aortic dissection with coronary heart disease, coronary intervention was performed immediately after successful complete closure of the incision with stent graft. One case of postoperative transient bilateral lower limb weakness, intravenous injection of anisodamine and mannitol recovered after 2 days. One case of stent covering the left subclavian artery opening resulted in left vertebral artery ischemia, drowsiness after 2 days self-improvement. Postoperative intensive care unit time 1 ~ 8 (average 3.5) days, the average postoperative hospital stay 10 days. Two patients died within 30 days after surgery, one died of ascending aortic dissection and one died of acute renal failure. Within 30 days after the death rate of 3.5%. The mean follow-up was (25.3 ± 13.1) (13-55) months. One patient died of massive hemoptysis 3 months after operation, and one died of unknown cause. A case of secondary endoluminal secondary repair of the cavity. Five patients underwent descending aortic stent-graft distal reoperation and found that the second endovascular repair. The incidence of postoperative paraplegia 0, no stent displacement, stenosis and other complications. The total postoperative hospital stay and follow-up was 7.0%. Compared with traditional surgery, endovascular treatment of acute thoracic aortic syndrome has the advantages of less trauma, less serious complications and shorter hospital stay. Conclusion The stent-graft is a good and effective method for the treatment of acute thoracic aortic syndrome. It can also be used in patients with high risk of surgical operation. The follow-up results in the recent and mid-term are good, and the long-term results need further follow-up.