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目的:探讨肾下主动脉夹层腔内修复治疗的效果与特点。方法:回顾性分析本科2004年1月至2010年11月期间15例以腔内修复为主治疗的肾下主动脉夹层。术前均通过MRA或CTA明确诊断。手术在DSA室进行,采用以腔内修复为主的方法进行治疗。病人术后1个月、3个月、6个月,以后每年于门诊进行随访。记录手术时间、出血量、总住院日数、随访时间和随访事件。结果:2例病人接受直管型移植物(支架型人工血管)植入;9例病人接受分叉型移植物植入;1例病人接受AUI型移植物植入、对侧髂动脉结扎加股-股人工血管旁路术;1例病人接受2枚直管型移植物植入、对侧髂动脉结扎加股-股人工血管旁路术;2例病人接受AUI型移植物植入,对侧髂动脉封堵器栓塞,加股-股人工血管旁路术。手术时间为(178±96)min,术中失血(152±103)mL,总住院时间为(11±5)d;随访时间(42±26)个月。1例病人6个月随访时发现存在少量内漏,随访24个月时假腔略有增大,但内漏消失;1例病人36个月时出现支架近端轻度移位,瘤腔未见扩大,未给予特殊处理;1例病人48个月时CTA检查发现股-股人工血管吻合口中度狭窄;2例病人随访半年后失访;其余10例病人随访结果满意。结论:腔内修复能有效治疗肾下主动脉夹层,具有简洁、微创的特点。远期疗效有待进一步观察。
Objective: To investigate the effect and characteristics of endovascular repair of subependymal aortic dissection. Methods: A retrospective analysis of 15 cases undergraduate endovascular treatment of subrenal aortic dissection between January 2004 and November 2010. Preoperative diagnosis by MRA or CTA. Surgery was performed in the DSA room using an endovascular repair-based approach. Patients 1 month, 3 months, 6 months after surgery, every year in the clinic for follow-up. The operation time, blood loss, total hospitalization days, follow-up time and follow-up events were recorded. Results: Two patients underwent straight-tube graft (stent-graft) implantation; nine patients underwent graft-for-graft implantation; one patient underwent AUI graft implantation and contralateral iliac artery ligation plus stock - One artificial bypass graft; one patient underwent two straight-tube graft implants and a contralateral iliac artery ligation plus femoral prosthesis bypass; two patients underwent AUI graft implantation and contralateral Iliac artery occlusion device plug, plus shares - artificial blood vessel bypass surgery. The operation time was (178 ± 96) min, blood loss was (152 ± 103) mL, total hospital stay was (11 ± 5) days and the follow-up time was (42 ± 26) months. One patient was found to have a small amount of endoleak at 6 months of follow-up. At 24 months of follow-up, there was a slight increase in the false lumen, but the endoleak disappeared. One patient showed mild proximal transposition of the stent at 36 months, See expanded, did not give special treatment; 1 patient at 48 months CTA examination found shares - artificial blood vessel anastomotic stenosis; 2 patients were followed up for six months after the loss of follow-up; the remaining 10 patients were satisfied with the follow-up results. Conclusion: Endovascular repair can effectively treat subrenal aortic dissection, with the characteristics of simplicity and minimally invasive. Long-term efficacy needs further observation.