不同期Stanford B型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究  

The efficacy of endovascular repair for Stanford B type aortic dissection of different pathological stages and the remodeling of aorta:a clinical study

作　　者：韩磊[1] 万珊杉 王家平[1] 杨帆[1] 吴敏[1] 何迷[1] 

机构地区：[1]昆明医科大学第二附属医院放射科,650101

出　　处：《介入放射学杂志》2016年第11期958-961,共4页Journal of Interventional Radiology

基　　金：云南省科学技术厅-昆明医科大学应用基础研究联合专项资金项目(2012FB045)

摘　　要：目的探讨不同疾病时期胸主动脉夹层(TAD)腔内修复术(TEVAR)后临床结局及主动脉重塑形态学特点。方法收集整理2005年2月至2015年2月收治的TEVAR术治疗Stanford B型TAD患者232例临床资料,对比分析术前临床和影像检查、术后随访结果。结果术前临床指标中真腔塌陷、瘤样扩张在亚急性组(n=62)分别为35.48%、12.90%,慢性组(n=170)分别为76.47%、64.12%,差异有显著统计学意义(P=0.000 1);胸主动脉假腔通畅在亚急性组为79.03%,慢性组为91.18%,差异有统计学意义(P=0.012)。232例TEVAR术均获成功。末次随访CTA检查结果显示,支架段胸主动脉假腔血栓完全吸收患者比例在亚急性组为90.00%,慢性组为48.52%,差异有显著统计学意义(P<0.000 1);假腔部分血栓形成患者比例在亚急性组为10.00%,慢性组为51.48%,差异有显著统计学意义(P<0.000 1);亚急性组手术前后夹层真假腔变化较慢性组明显,差异有显著统计学意义(P<0.000 1)。结论亚急性期TAD稳定,TEVAR术后疗效良好,主动脉壁形态学重塑优于慢性期患者。Objective To investigate the clinical outcome of sub-acute and chronic Stanford B type thoracic aortic dissection （TAD） after thoracic endovascular aueurysm repair （TEVAR） and to discuss the morphological features of aortic remodeling. Methods The clinical data of 232 patients with Stanford B type TAD, who were admitted to authors＇ hospital during the period from February 2005 to February 2015 to receive TEVAR, were collected and reviewed. The preoperative clinical materials and imaging findings as well as the follow-up results were analyzed. Results The analysis results of preoperative clinical indexes showed that true lumen collapse and aneurysmal dilatation in sub-acute TAD group （n=62） were 35.48% and 12.90% respectively, which were 76.47% and 64.12%, respectively in chronic TAD group （n=170）; the differences between the two groups were statistically significant （P=0.000 1）. The patency rates of the false lumen in sub-acute TAD group and in chronic TAD group were 79.03% and 91.18% respectively; the difference between the two groups was statistically significant （P=0.012）. Successful TEVAR was achieved in all 232 patients. The last follow-up CT examination demonstrated that the proportions of complete absorption of false lumen thrombus at stenting segment of thoracic aorta in sub-acute TAD group and in chronic TAD group were 90.00% and 48.52% respectively; the difference between the two groups was statistically significant （P〈0.000 1 ）. Partial thrombosis of false lumen in sub-acute TAD group and in chronic TAD group was 10.00% and 51.48% respectively; the difference between the two groups was statistically significant （P〈 0.000 1 ）. After TEVAR, the changes of the true and false lumen in the sub-acute TAD group were more obvious than those in the chronic TAD group; the differences between the two groups were statistically significant （P〈0.000 1 ）. Concluslon In the sub-acute stage of TAD, when it is in a steady state, TEVAR can obtain good curative result, and the m

关 键 词：腔内修复术 胸主动脉夹层 治疗效果 重塑 

分 类 号：R543.1[医药卫生—心血管疾病]