中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

B 型夹层腔内修复术后并发 A 型夹层的外科治疗

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目的 总结 B 型主动脉夹层腔内修复术(TEVAR)后并发 A 型夹层的临床特点及外科治疗经验。 方法 自 2013 年 11 月至 2018 年 3 月,南京鼓楼医院共外科治疗 B 型主动脉夹层 TEVAR 术后 A 型夹层 14 例,平均年龄 24~66(52±3)岁,合并高血压 13 例,糖尿病 2 例,马凡综合症 1 例。所有患者在深低温停循环选择性脑灌注下施行手术,近心端 13 例行升主动脉置换术,1 例行 Bentall 术。共实施全弓置换加象鼻手术 13 例,弓部开窗支架植入术 1 例, 结果 全组无死亡,1 例术后右上肢单瘫,1 例术后血行感染,1 例出现右侧偏瘫及肾功能不全行肾脏替代治疗。随访期间 1 例患者术后 1 个月因原介入支架远端胸降主动脉发生新的夹层再次行 TEVAR。其余患者 CT 血管造影检查未见吻合口造影剂渗漏及人工血管扭曲。 结论 B 型夹层 TEVAR 术后并发 A 型夹层及时给予外科手术治疗可取得良好疗效。

关键词: 主动脉夹层; Stanford A 型; Stanford B 型; 胸主动脉腔内修复术

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