贺一伟 熊盼 张永恒 刘建平 唐小娇

[摘要] Standford B型主动脉夹层病情凶险，死亡率高，一经确诊需要立即手术，胸主动脉腔内修复术（TEVAR）是Standford B型主动脉夹层首选治疗方案，但术后支架远端破裂已经成为TEVAR术不可忽视的并发症，对此并发症处理十分重要。笔者分析2018年5月24日四川省遂宁市中心医院收治的1例TEVAR术后支架远端主动脉夹层先兆破裂经再次TEVAR术救治患者的临床資料，发现TEVAR术后发生支架远端破入胸腔，经再次行TEVAR术，并辅以纠正休克、纠正低蛋白血症、胸腔穿刺引流为主等综合治疗，术后恢复良好，同时未出现严重并发症，提示TEVAR术治疗Standford B主动脉夹层为有效治疗方案。

[关键词] Standford B型主动脉夹层;胸主动脉腔内修复术;并发症;胸腔积液

[中图分类号] R543.1          [文献标识码] A          [文章编号] 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型主动脉夹层病情凶险，死亡率高，一经确诊需要立即手术，胸主动脉腔内修复术（TEVAR）是Standford B型主动脉夹层首选治疗方案，但TEVAR术后仍存在许多严重并发症（如支架内漏、脊髓缺血、脑卒中、逆行A型主动脉夹层、支架移位、远端支架破裂等），现将四川省遂宁市中心医院（以下简称“我院”）1例患Standford B型主动脉夹层行TEVAR术后并发远端支架破裂患者的临床资料、治疗经过分析如下：

1 病例资料

患者，男，59岁，因“突发胸背部疼痛2 d，加重4 h”于2018年5月24日入住我院。患者突发胸背部疼痛2 d，加重4 h，为不能缓解的刀割样剧烈疼痛，休息时不能缓解，伴咳嗽咳痰，咳黄色黏稠痰液，急送我院就诊。查体：脉搏85次/min，血压86/40 mmHg（1 mmHg=0.133 kPa），呼吸20次/min，左肺呼吸音减弱，右肺呼吸音增粗，心率85次/min，无病理性杂音，腹部软，无压痛及反跳痛，腹部未闻及血管杂音，无双下肢水肿。……