目的著重從力學(xué)損傷的角度分析胸主動(dòng)脈腔內(nèi)修復(fù)(TEVAR)術(shù)后并發(fā)人工血管內(nèi)支架(簡(jiǎn)稱支架)源性新破口(SINE)的原因及其防治措施。方法本研究中SINE定義為: 排除了腔內(nèi)操作導(dǎo)致的醫(yī)源性損傷和自然病程進(jìn)展，由支架本身引起的、發(fā)生在支架兩端的新破口，出現(xiàn)在支架近端和遠(yuǎn)端者分別稱為近端SINE和遠(yuǎn)端SINE。回顧性收集2000年8月至2008年6月期間在我院接受TEVAR治療的650例Stanford B型主動(dòng)脈夾層中22例并發(fā)SINE患者的臨床資料，另有1例Stanford B型主動(dòng)脈夾層在外院完成初次TEVAR后14個(gè)月并發(fā)遠(yuǎn)端SINE來我院治療。分析SINE發(fā)生的時(shí)間、臨床表現(xiàn)、治療、隨訪效果及其原因。結(jié)果本組有23例SINE共24處破口，其中近端SINE 15例(16處)，遠(yuǎn)端SINE 7例(8處)，1例患者先后在支架近、遠(yuǎn)端出現(xiàn)破口。我院SINE總體發(fā)生率為3.4%(22/650)，死亡6例，死亡率為26.1%(6/23)。16處近端SINE均位于主動(dòng)脈弓大彎側(cè)，導(dǎo)致逆行性A型夾層。8處遠(yuǎn)端SINE均出現(xiàn)在撕裂的內(nèi)膜片一側(cè)，其中5例引起夾層動(dòng)脈瘤持續(xù)增大，3例隨訪穩(wěn)定。23例患者初次TEVAR治療中支架均跨主動(dòng)脈弓降部釋放。結(jié)論TEVAR術(shù)后并發(fā)SINE并不罕見，死亡率高。支架導(dǎo)致的力學(xué)損傷是SINE形成的重要潛在因素，支架設(shè)計(jì)和圍手術(shù)期評(píng)估時(shí)重視該因素的評(píng)估具有重要意義。
引用本文： 董智慧,符偉國,王玉琦,郭大喬,徐欣,陳斌,蔣俊豪,楊玨,史振宇,竺挺,石赟. 胸主動(dòng)脈腔內(nèi)修復(fù)術(shù)后支架源性新破口——從支架力學(xué)損傷角度的思考. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(10): 1031-1038. doi: 復(fù)制
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