胸腔积液在Stanford B型主动脉夹层腔内治疗中的意义及转归  

Clinical significance and outcomes of pleural effusion in patients with type B aortic dissection treated by endovascular repair

作　　者：查斌山[1] 朱化刚[1] 谢文涛[1] 张志功[1] 李永生[1] 叶雨生[1] 刘斌[1] 陈智勇[1] 余康敏[1] 魏猛[1] 李俊[1] 

机构地区：[1]安徽医科大学第一附属医院血管外科,合肥230022

出　　处：《中华普通外科杂志》2017年第12期1018-1021,共4页Chinese Journal of General Surgery

摘　　要：目的探讨胸腔积液在Stanford B型主动脉夹层中的临床意义及转归。方法回顾性分析2015年1月至2016年12月我院收治的28例主动脉夹层（aortic dissection，AD）合并胸腔积液患者的临床资料。包括破裂型夹层（ruptured aortic dissection，RAD）7例和包裹型夹层（contained aortic dissection，CAD）21例。结果全组共26例接受了腔内治疗，手术成功率100％．5例接受急诊腔内修复术（6—48h），无支架源性夹层发生。2例患者在保守治疗期间死亡。胸腔积液分布情况为左侧20例（71．4％）、右侧2例（7．1％）和双侧6例（21．4％）。胸腔积液的分布方式与夹层分组有关（χ^2=10．4，P〈0．05），其中右侧风险比例明显高于左侧和双侧。右侧胸腔积液量在RAD组中值高于CAD组（Z=-3．293，P=0．001）。采用控制性胸腔抽液治疗共5例：术后3例，术中2例。1例患者术后第9天猝死。25例完成随访，随访时间1—18个月，平均（10．04±4．86）个月，未出现内漏、肺不张及胸膜增厚等。随访时间超过3个月的24例患者胸腔积液均完全吸收。结论主动脉夹层常合并左侧胸腔积液，大量右侧胸腔积液多提示破裂风险。血管腔内治疗合并胸腔积液主动脉夹层安全有效．短期效果好。Objective To explore clinical implications of pleura[ effusion in thoracic endovascular aorta repair （TEVAR） of type B aortic dissection. Methods Clinical data of 28 patients （23 males, 5 females） hospitalized from Jan 2015 to Dee 2016 were analyzed retrospectively. There were ruptured aortic dissection （RAD） （n =7） and the contained aortic dissection （CAD） （n = 21 ） . 26 patients underwent TEVAR, and two patients received conservative treatment. Results 26 patients received TEVAR and operations were successful. 2 patients treated conservatively died. Six patients had bilateral pleural effusion, while 20 had left pleural effusion and two had right p]eural effusion. The distribution of pleural effusion was significantly different between CAD and RAD group （χ^2 = 10. 4, P 〈 0. 05 ） , and the rupture risk was the highest in right sided p]eural effusion. The median volume of pleural effusion on right side in RAD group are higher than that in CAD group （Z = -3. 293 ,P = 0. 001 ）. One patient died of sudden death on post-op 9th day. Pleura] effusion disappeared in all 24 patients who were followed-up for more than 3 months. There were no ensuing pleural thickening, pulmonary ateiectasis, and lung consolidation. Conclusions Pleural effusion on left side are common in type B aortic dissection, while bulk right pleural effusion may indicate impending rupture . Endovaseular therapy is a feasible, safe and effective therapy for aortic dissection with pleural effusion.

关 键 词：动脉瘤 夹层 胸腔积液 腔内修复 

分 类 号：R543.1[医药卫生—心血管疾病]