摘要目的 探讨腔内修复术治疗原发内膜破口位于主动脉弓远端或降主动脉的逆撕型Stanford A型主动脉夹层的近中期结果.方法 2009年12月至2014年12月南京军区南京总医院心胸外科对21例原发性逆撕型Stanford A型主动脉夹层行腔内修复治疗.患者均为男性,年龄32～74岁,平均年龄(52 ±9)岁.17例患者升主动脉表现为单纯壁间血肿,4例表现为假腔活动血流和部分血栓形成;8例患者降主动脉表现为起始部溃疡合并壁间血肿形成,13例患者降主动脉形成真假腔双腔走血典型夹层改变.所有患者接受血管腔内覆膜支架修复术,急性期手术15例,慢性期手术6例.结果 全组患者植入锥形支架13例,直筒型支架8例,其中1例行左颈总-左锁骨下动脉旁路术,1例植入限制性裸支架.术后2例患者气管切开,围手术期无脑卒中、截瘫、支架破裂或移位、肢体或腹腔器官缺血等并发症,无死亡病例.术后随访6 ～72个月,所以患者升主动脉、主动脉弓壁间血肿完全吸收.1例出现Ⅰ型内漏、溃疡扩大,1例支架远端Ⅳ型内漏.1例患者于术后2年外伤后复查见升主动脉夹层,后于心肺转流下行杂交手术治愈.结论 腔内修复术治疗原发性逆撕型Stanford A型主动脉夹层安全有效,近中期效果良好.

abstractsObjective To summarize the short-and mid-term results on endovascular repair of primary retrograde Stanford type A aortic dissection with an entry tear in distal aortic arch or descending aorta.Methods Between December 2009 and December 2014,21 male patients of primary retrograde Stanford type A aortic dissection with a mean age of (52 ± 9) years received endovascular repair in Department of Cardiothoracic Surgery,Jinling Hospital.Among the 21 cases,17 patients were presented as ascending aortic intramural hematoma,4 patients as active blood flow in false lumen and partial thrombosis,8 patients as ulcer on descending aorta combined intramural hematoma in descending aorta,and 13 patients as typical dissection changes.All patients received cndovascular stent-graft repair successfully,with 15 cases in acute phase and 6 cases in chronic phase.Results Cone stent was implanted in 13 cases,while straight stent in 8 cases,including 1 case of left common carotid-left subclavian artery bypass surgery and 1 case of restrictive bare-metal stent implantation.No perioperative stroke,paraplegia,stent fracture or displacement,limbs or abdominal organ ischemia or other severe complications occured,except for tracheotomy in 2 patients.Active blood flow in ascending aorta or aortic arch disappeared,and intramural hematoma started being absorbed on CT angiography images before discharge.All patients were alive during follow-up (6 to 72 months),and intramural hematoma in ascending aorta and aortic arch was absorbed thoroughly.Type Ⅰ endoleak and ulcer expansion were found in 1 patient,and type Ⅳ endoleak in distal stent was found in another one patient.Secondary ascending aortic dissection was found in 1 case two years later,which was cured by hybrid procedure with cardiopulmonary bypass.Conclusion Endovascular repair of primary retrograde Stanford type A aortic dissection was safe and effective,which correlated with favorable short-and mid-term results.