3种覆膜支架行Stanford B型主动脉夹层腔内修复术的早期和中期疗效  

The early and mid-term results of three types of stent-grafts used in TEVAR for Stanford B aortic dissection

作　　者：任长伟[1] 许尚栋[1] 黄连军[1] 郭曦[1] 阳晟[1] 金秀峰[1] 周坤[1] 高慧强[1] 刘朝亮[1] 孙立忠[1] 

机构地区：[1]北京市心肺血管疾病研究所,首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2014年第11期657-659,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 对比3种覆膜支架治疗Stanford B型主动脉夹层的早期和中期疗效.方法 2001年6月至2008年12月,203例Stanford B型主动脉夹层患者腔内修复术分别使用Grikin、Hercules和Talent 3种品牌的覆膜支架,Grikin组59例、Hercules组91例、Talent组53例,截至2012年7月,患者随访1～ 132个月,平均（57.0±22.7）个月.出院前行胸部大血管CTA检查,其后每年复查CTA.记录并比较3组患者早、中期疗效,包括术后死亡比例、严重并发症的发生率、随访期死亡比例和二次手术率.结果 3组患者30天内死亡分别为Grikin组3例（5.1％,3/59）,Hercules组3例（3.3％,3/91）,Talent 组2例（3.8％,2/53）,P=0.890.随访期间死亡Grikin组12例（21.4％,12/56）、Hercules组11例（12.5％,11/88）、Talent组11例（21.6％,11/51）,P=0.260.Kaplan-Meier生存分析,术后8年3组生存率分别为Grikin组71.1％、Hercules组84.1％、Talent组66.0％,P=0.057.3组中支架远端明显扩张的患者为Grikin组2例（3.6％,2/56）,Hercules组15例（17.0％,15/88）,Talent组9例（17.6％,9/51）,P=0.025.随访期内接受二次腔内修复术Grinkin组4例（7.1％,4/56）,Hercules组6例（6.8％,6/88）,Talent组4例（7.8％,4/51）,P=0.980.术后8年免于二次腔内修复术的比率分别为Grinkin组90％,Hercules组88.7％,Talent组84.0％.结论 在Stanford B型主动脉夹层腔内修复术中3种覆膜支架的早期疗效、随访期生存率,二次手术率无显著差异.覆膜支架远端过度扩张的比例,Grikin组显著低于Hercules组和Talent组.渐细覆膜支架更适合于Stanford B型主动脉夹层腔内修复术.Objective To compare early and mid-term results of three types of stent-grafts in thoracic endovascular aortic repair（TEVAR） for Stanford B aortic dissection.Methods From June 2001 to December 2008,203 patients underwent TEVAR.Among them,53 patients used Talent stent-grafts,91 used Hercules stent-grafts and 59 with Grinkin stent-grafts.All patients have been followed up from 1 to 132 months by the end of July 2012,with average duration of（57.0 ± 22.7） months.All patients took CTA before discharge and once a year afterwards.Mid-term outcomes of the three groups including mortality,stent-graft related complications,and morphologic change of descending aorta were compared.Results Mortality within 30 days after operation：5.1% in Grinkin group（3 case）,3.3% in Hercules group（3 cases）,and 3.8% in Talent group （2cases）,P =0.890.During the follow-up,the mortality is 21.4% in Grinkin group（12 cases）,12.5% in Hercules group （11 cases）,21.6% in Talent group（11 cases）,P =0.260.Kaplan-Meier survival curve showed the survival rates 8 years after operation are 71% in Grikin group,84.0% in Hercules group and 66% in Talent group,P =0.057.The expanding of the distal end of stent-grafts are：3.6% in Grikin group（2 cases）,17.0% in Hercules group（15 cases）,and 17.6% in Talent group（9 cases）.Four patients（7.1%） received second operation in Grinkin group,six（6.8%） in Hercules group and four （7.8%） in Talent group during the follow-up clinic.During the 8 years after operation,90.0% of patients avoided second operation in Grinkin group,88.7% avoided second operation in Hercules group and 84.0% avoided it in Talent group.Conclusion There is no significant difference among three groups regarding early and mid-term mortality.The difference between the diameter of the distal end of stent-graft and the diameter of the distal descending aorta is much higher in Talent group and Hercules group than that in Grikin group.Flexible stent-graft with a tapered design is more suitable for TEVAR

关 键 词：主动脉夹层 覆膜支架 腔内修复 主动脉扩张 

分 类 号：R654.3[医药卫生—外科学]