目的：探讨局部浸润麻醉下行腔内隔绝术（ EVGE）治疗急性Stanford B型主动脉夹层（ AAD）的经验。方法：对40例AAD患者行EVGE术的临床资料、治疗经过进行回顾性分析。结果：40例患者均成功行EVGE术治疗。术后即刻造影证实夹层近端破裂口封堵完全，其中2例出现Ⅰ型内漏，1例出现Ⅱ型内漏，13例出现Ⅳ型内漏。术后无截瘫、支架移位发生。随访6~24个月，1例复查CTA提示降主动脉远端继发破口未愈合，假腔进行性增大，再次手术置入一枚锥形支架移植物，破口成功封堵。余病例原假腔明显缩小，真腔增大接近正常，未发生再次夹层及死亡病例。结论：局部浸润麻醉下行EVGE术治疗急性Stanford B型主动脉夹层技术成功率高、创伤小、恢复快、并发症少、死亡率低。%Objective To investigate the local infiltration anesthesia for endovascular graft exclusion( EVGE)for treatment of acute Stanford type B aortic dissection( AD)experience. Method In 40 cases( male 28 cases,female 12 cases,age 37 ~ 70 years old)clinical data of patients with EVGE,patients with AD were analyzed retrospectively. Results The patients were successfully performed in 40 patients with EVGE. The immediate postoperative angiography dissection proximal rupture complete closure,including 2 cases of type I internal leak-age,occurred in 1 cases,type II internal leakage,occurred in 13 cases,type IV internal leakage. No postoperative paraplegia,stent migration occurred. Follow-up for 6 ~ 24 months,1 cases of CTA showed that the descending aorta distal secondary break did not heal,the false lu-men were enlarged,again operation with a conical stent graft,break in plugging. There was the original false lumen was significantly re-duced,the true lumen increased nearly normal,no recurrence of interlayer and deaths. Conclusion Local infiltration anesthesia in EVGE for the treatment of acute type Stanford B aortic dissection technology with high success rate,little trauma,quick recovery,less complications, low mortality.
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