B型胸主動(dòng)脈夾層動(dòng)脈瘤的治療策略課件

TheTherapeuticStrategyforTypeBThoracicAorticDissectionPeople’sHospital,PekingUniversity北京大學(xué)人民醫(yī)院XieJiyan(解基嚴(yán)),etal,編輯課件TheTherapeuticStrategyPeopl1TheTherapyforTypeBThoracicAorticDissectionMedicalSurgicalEndovascular編輯課件TheTherapyforTypeBMedical2ClinicalMaterialMale74Famale4Age:55~73yHypertension:51CAD:4Chronicrenalinsufficiency:4Diabetesmellitus41990~2005Chronicpulmonaryocclusiondisease:19編輯課件ClinicalMaterialMale74378casesAcute34Chronic44ClinicalMaterial編輯課件78casesAcute34Chronic44Cli4ChestPainHeart\renal\lungSymptoms

(ShortBreath)Pulse:Decreased（60%）BP:NormalorHighSymptoms&Signs編輯課件ChestPainHeart\renal\lungSym5DiagnosisMethodsEchocardiogram(TTE&TEE)CTMRIAngiography編輯課件DiagnosisMethodsEchocardiogr6SurgicalTherapy（48）MedicalTherapy（30）Localresection&patch2Prostheticvesselreplacement3EndovascularStent15Actue（17）Chronica（31）Prostheticvesselreplacement14EndovascularStent14編輯課件SurgicalTherapy（48）Medic748Localresection&patch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortality

編輯課件48Localresection&patch8Onestent21Twostents6Results:NooperativedeathComplications:Leak2Threestents1編輯課件Onestent21Twostents6Re9

Rupture：4/6

Trachea：1Esophagus：1Chest：2Latetermdeath：8Results:MedicalTherapymortality（30）編輯課件Results:MedicalTherapym10Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29

(3mon.~4years):Nocomplications&death編輯課件Results:Long-termProsthetic11OneyearafterimplantStent編輯課件OneyearafterimplantStent編輯12Discussion編輯課件Discussion編輯課件13Medicalvs

Surgical?TheTimeofSurgery：EmergencyvsSelective?OperativeMethods：ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissection編輯課件MedicalvsSurgical?TheTimeo14COBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonist?—Blocker編輯課件COBPTheTherapyforTypeBMedi15TheComplicationsofSurgeryTraumaAnesthesiaBleedingSpinalinjuryBrainRenalLungsAMI編輯課件TheComplicationsofSurgeryTr16EndovascularGraftMethods

1.Byfemoralartery

2.ByAorticArch編輯課件EndovascularGraftMeth17TheExcellencesofEndovasculartherapyInvasive&safetherapyReducetheoperativemorbidity&mortalitySaveBloodItisanewandeffectivetherapy編輯課件TheExcellencesofInvasive18LocalAnatomyConditionAgeImportantOrgansFunctionsTheTherapyforTypeBThoracicAorticDissectionThelengthoftheneckTheShapeofthetrue&falselumenThearterybranchTheperipheralarteriesThegeneralcondition

編輯課件LocalAnatomyConditionAgeImpo19leakNeckthetrueconditionArteriesbranchTheReasonsoftheleakSurgeon11%~44%11%~44%Prosthetic

編輯課件leakNeckthetrueconditionAr20DiagnosisMildAngiographyCTPrevent&TreatmentLeak(I)TreatmentSeverere-do-stentSurgicalObservation編輯課件DiagnosisMildAngiographyCTPre21Prevent&TreatmentLeak(II)PatientsStentsAnatomySurgicalSkill編輯課件Prevent&TreatmentLeak(II)P22Multiplelaceration&SegmentsHugefalselumenTruelumen:small,neck,cylinderImportanceorgansperfusion?

(bythefalselumen)TheperipheralarteriesLongtermoftheeffects?ChronicTypeBPath-physiological編輯課件Multiplelaceration&Segments23Makingsurediagnosis(ClinicalDiagnosis)TheDiagnosisofAorticDissectionConclusion(I)Complications?(Pathologic&PhysiologicDiagnosis)Thelocation&range(PathologicDiagnosis)編輯課件MakingsurediagnosisTheDiagn24Multi-expertiseCooperation：Surgeon,Physician、Radiology、AnesthesiaMulti-therapy：Medicinal、Surgical、EndovascularConsideration：

Pathology&physiology（CT，MRI，Angiography)Conclusion(II)編輯課件Multi-expertiseCooperation：Mu25Conclusion(III)MedicalEndovascularSurgicalSub-acuteBChronicBAcutephase

PostOPFirstchoice?!編輯課件Conclusion(III)MedicalEndov26Acute

RepeatPainHypertensionDiameterexpandquicklyRuptureMal-perfusionSub-acuteorChronicDiameter>5cmWhthinoneyear>1cmTheTherapyforTypeBThoracicAorticDissectionSurgicalIndications編輯課件AcuteSub-acute27Thanks2005.Nov.Beijing編輯課件Thanks2005.Nov.Beijing編輯課件28TheTherapeuticStrategyforTypeBThoracicAorticDissectionPeople’sHospital,PekingUniversity北京大學(xué)人民醫(yī)院XieJiyan(解基嚴(yán)),etal,編輯課件TheTherapeuticStrategyPeopl29TheTherapyforTypeBThoracicAorticDissectionMedicalSurgicalEndovascular編輯課件TheTherapyforTypeBMedical30ClinicalMaterialMale74Famale4Age:55~73yHypertension:51CAD:4Chronicrenalinsufficiency:4Diabetesmellitus41990~2005Chronicpulmonaryocclusiondisease:19編輯課件ClinicalMaterialMale743178casesAcute34Chronic44ClinicalMaterial編輯課件78casesAcute34Chronic44Cli32ChestPainHeart\renal\lungSymptoms

(ShortBreath)Pulse:Decreased（60%）BP:NormalorHighSymptoms&Signs編輯課件ChestPainHeart\renal\lungSym33DiagnosisMethodsEchocardiogram(TTE&TEE)CTMRIAngiography編輯課件DiagnosisMethodsEchocardiogr34SurgicalTherapy（48）MedicalTherapy（30）Localresection&patch2Prostheticvesselreplacement3EndovascularStent15Actue（17）Chronica（31）Prostheticvesselreplacement14EndovascularStent14編輯課件SurgicalTherapy（48）Medic3548Localresection&patch00/2Prostheticvesselreplacement32/14EndovascularStent0/140/15EmergencySelectiveAMIBleedingResults:operativemortality

編輯課件48Localresection&patch36Onestent21Twostents6Results:NooperativedeathComplications:Leak2Threestents1編輯課件Onestent21Twostents6Re37

Rupture：4/6

Trachea：1Esophagus：1Chest：2Latetermdeath：8Results:MedicalTherapymortality（30）編輯課件Results:MedicalTherapym38Results:Long-termProstheticvesselreplacement12(1~7years):Hoarse3/5Death2EndovascularStent29

(3mon.~4years):Nocomplications&death編輯課件Results:Long-termProsthetic39OneyearafterimplantStent編輯課件OneyearafterimplantStent編輯40Discussion編輯課件Discussion編輯課件41Medicalvs

Surgical?TheTimeofSurgery：EmergencyvsSelective?OperativeMethods：ConventionalvsEndo?TheTherapyforTypeBThoracicAorticDissection編輯課件MedicalvsSurgical?TheTimeo42COBPTheTherapyforTypeBThoracicAorticDissectionMedicalTherapyVascularDilatorCalciumantagonist?—Blocker編輯課件COBPTheTherapyforTypeBMedi43TheComplicationsofSurgeryTraumaAnesthesiaBleedingSpinalinjuryBrainRenalLungsAMI編輯課件TheComplicationsofSurgeryTr44EndovascularGraftMethods

1.Byfemoralartery

2.ByAorticArch編輯課件EndovascularGraftMeth45TheExcellencesofEndovasculartherapyInvasive&safetherapyReducetheoperativemorbidity&mortalitySaveBloodItisanewandeffectivetherapy編輯課件TheExcellencesofInvasive46LocalAnatomyConditionAgeImportantOrgansFunctionsTheTherapyforTypeBThoracicAorticDissectionThelengthoftheneckTheShapeofthetrue&falselumenThearterybranchTheperipheralarteriesThegeneralcondition

編輯課件LocalAnatomyConditionAgeImpo47leakNeckthetrueconditionArteriesbranchTheReasonsoftheleakSurgeon11%~44%11%~44%Prosthetic

編輯課件leakNeckthetrueconditionAr48DiagnosisMildAngiographyCTPrevent&TreatmentLeak(I)TreatmentSeverere-do-stentSurgicalObservation編輯課件DiagnosisMildAngiographyCTPre49Prevent&TreatmentLeak(II)PatientsStentsAnatomySurgicalSkill編輯課件Prevent&TreatmentLeak(II)P50Multiplelaceration&SegmentsHugefalselumenTruelumen:small,neck,cylinderImportanceorgansperfusion?

(bythefalselumen)TheperipheralarteriesLongtermoftheeffects?ChronicTypeBPath-physiological編輯課件Multiplelaceration&Segments