2021年 · 第36卷第01期

1999, Dake et al.^[1]And Nienaber et al.^[2]The use of endoluminal stents in the treatment of acute aortic dissection and Stanford type B aortic dissection, respectively, was reported in the New England Journal of Medicine, marking a milestone shift in the treatment of thoracic aortic dissection. Studies have pointed out that thoracic endovascular aortic repair (TEVAR) has advantages in both short-term and long-term prognosis over optimal medical treatment; Compared with open surgery, TEVAR also has better short-term efficacy and similar long-term prognosis^[3]。 With the advancement of research, the treatment guidelines for aortic dissection are gradually updated. TEVAR has gradually developed from the initial treatment of complex type B dissection to the treatment of partial type A dissection and non-A and non-B dissection (aortic dissection involving the arch)^[4]。 At the same time, since only the primary rupture is covered, a considerable number of patients will develop distal abdominal aortic aneurysm-like dilatation after surgery^[5,6]How to improve the long-term prognosis of TEVAR and promote aortic remodeling is the current focus. In this paper, the extension of proximal anchoring area and remodeling of distal aorta are briefly described in the clinical research of aortic dissection in recent years.

An 18-year-old male complained of "the discovery of a submental mass for more than 4 months". Physical examination: A tough mass about 4 cm in diameter under the chin, with a clear boundary, can be pushed. Both thyroid glands were palpable with 1 cm diameter masses, which were hard, fixed and unclear. The enlarged lymph nodes were not palpable. Laboratory tests showed that serum T3, T4, FT3, FT4, TSH, TPO-Ab and Tg-Ab were normal. Ultrasound: Bilateral thyroid nodules (TI-RADS4c), multiple enlarged lymph nodes and submental cystic-solid mass were seen in areas III, IV and VI of the left cervix and IV and VI of the right cervix. Total thyroidectomy + prehyoid mass resection + thyroglossal duct resection + partial hyoid resection + bilateral lymph node dissection in zone Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅵ were performed (Figure 1), postoperative pathological report: bilateral papillary thyroid carcinoma without vascular tumor thrombus and nerve invasion, involving thyroid envelope; Papillary thyroid carcinoma can be seen in the prehyoid mass. Metastatic carcinoma was seen in lymph nodes (19/81). Mutation of the BRAF V600E gene in the prehyoid mass. Postoperative line¹³¹I treatment and TSH inhibition, no recurrence and metastasis were observed after 15 months follow-up.

A 60-year-old male was admitted to the hospital due to "sudden pain and discomfort in the waist and abdomen after lifting heavy objects for 1 d". Has a history of "hypertension" for more than 10 years, and has not been treated with drugs. In the past 5 years, I raised goats at home, and I complained that there were no sick goats. Physical examination: soft abdomen, mild tenderness around the umbilicus to the left, and no pulsatile mass. CTA: pseudoaneurysm of the abdominal aorta, blood culture: Brucella (+). Diagnosis: infected abdominal aortic pseudoaneurysm; Hypertension grade 3. Rifampicin + doxycycline were given as anti-infective therapy. After 4 weeks, the CTA was re-examined: the aneurysm was 7 mm larger than before. Surgical treatment was decided. Localized bulge about 2 cm above the bifurcation level of the abdominal aorta was observed during the operation, and severe adhesion to the duodenum and inferior vena cava was observed. The abdominal aorta was controlled at the proximal end of the lesion, and the tumor body and surrounding adhesive tissues were separated by intermittently blocking the abdominal aorta. The arterial wall of the lesion was removed and the infected tissue around the lesion was completely removed. After the arterial wall was trimmed, the defect was about 2 cm ×3 cm in size. The aponeurosis and parietal peritoneal tissue of the posterior rectus abdominis sheath were taken above the umbilical level, and the abdominal aortic wall was repaired in situ (Figure 1)。 Symptomatic treatment such as anti-infection was continued after surgery. After 1 and 12 months after operation, CTA showed that the abdominal aorta was in good shape, and there was no abnormal bulge or aneurysm formation at the artery repair site (Figure 2)。