TEVAR術后支架遠端主動脈夾層先兆破裂經再次TEVAR術救治1例并文獻分析

賀一偉 熊盼 張永恒 劉建平 唐小嬌

[摘要] Standford B型主動脈夾層病情兇險，死亡率高，一經確診需要立即手術，胸主動脈腔內修復術（TEVAR）是Standford B型主動脈夾層首選治療方案，但術后支架遠端破裂已經成為TEVAR術不可忽視的并發(fā)癥，對此并發(fā)癥處理十分重要。筆者分析2018年5月24日四川省遂寧市中心醫(yī)院收治的1例TEVAR術后支架遠端主動脈夾層先兆破裂經再次TEVAR術救治患者的臨床資料，發(fā)現TEVAR術后發(fā)生支架遠端破入胸腔，經再次行TEVAR術，并輔以糾正休克、糾正低蛋白血癥、胸腔穿刺引流為主等綜合治療，術后恢復良好，同時未出現嚴重并發(fā)癥，提示TEVAR術治療Standford B主動脈夾層為有效治療方案。

[關鍵詞] Standford B型主動脈夾層;胸主動脈腔內修復術;并發(fā)癥;胸腔積液

[中圖分類號] R543.1? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）07（c）-0167-05

One case with threatened rupture of distal aortic dissection after TEVAR treated by TEVAR one more and literature analysis

HE Yiwei1，2? ?XIONG Pan3? ?ZHANG Yongheng1? ?LIU Jianping1? ?TANG Xiaojiao1

1.Department of Cardiovascular Surgery， Central Hospital of Suining City， Sichuan Province， Suining? ?629000， China; 2.Department of Surgery， Affiliated Hospital of Zunyi Medical College， Guizhou Province， Zunyi? ?563100， China; 3.Department of Anesthesiology， Central Hospital of Suining City， Sichuan Province， Suining? ?629000， China

[Abstract] Standford type B aortic dissection is dangerous and has a high mortality rate. Once this disease is diagnosed， immediate surgery is needed. Thoracic endovascular aortic repair （TEVAR） is the first treatment for Standford type B aortic dissection， but distal stent rupture has become a complication of TEVAR， which is very important to deal with. The author analyzes the clinical data of one patient with rupture of distal aortic dissection after TEVAR treated by TEVAR one more on May 24， 2018 in Suining Central Hospital of Sichuan Province. It was found that the distal stent ruptured into thoracic cavity after TEVAR， then the patients were treated by TEVAR again and assisted by shock correction， hypoproteinemia correction， thoracic drainage and thoracentesis as the main comprehensive treatment， the postoperative recovery is good， with no serious complications. It is suggested that TEVAR is an effective treatment for Standford B aortic dissection.

[Key words] Standford type B aortic dissection; Thoracic endovascular aortic repair; Complication; Pleural effusion

Standford B型主動脈夾層病情兇險，死亡率高，一經確診需要立即手術，胸主動脈腔內修復術（TEVAR）是Standford B型主動脈夾層首選治療方案，但TEVAR術后仍存在許多嚴重并發(fā)癥（如支架內漏、脊髓缺血、腦卒中、逆行A型主動脈夾層、支架移位、遠端支架破裂等），現將四川省遂寧市中心醫(yī)院（以下簡稱“我院”）1例患Standford B型主動脈夾層行TEVAR術后并發(fā)遠端支架破裂患者的臨床資料、治療經過分析如下：

1 病例資料

患者，男，59歲，因“突發(fā)胸背部疼痛2 d，加重4 h”于2018年5月24日入住我院。患者突發(fā)胸背部疼痛2 d，加重4 h，為不能緩解的刀割樣劇烈疼痛，休息時不能緩解，伴咳嗽咳痰，咳黃色黏稠痰液，急送我院就診。查體：脈搏85次/min，血壓86/40 mmHg（1 mmHg=0.133 kPa），呼吸20次/min，左肺呼吸音減弱，右肺呼吸音增粗，心率85次/min，無病理性雜音，腹部軟，無壓痛及反跳痛，腹部未聞及血管雜音，無雙下肢水腫。……