急性Stanford B型主动脉夹层腔内修复治疗111例分析  

Analysis of thoracic endovascular aortic repair for 111 patients with acute type B aortic dissection

作　　者：刘志红[1] 蒙茂龙[1] 魏民新 李刚[1] 王湘[1] 郭建洲[1] 张锐[1] 王赞鑫 杨建安[1] LIU Zhi-hong;MENG Mao-long;WEI Min-xin;LI Gang;WANG Xiang;GUO Jian-zhou;ZHANG Rui;WANG Zan-xin;YANG Jian-an(Department of Cardiac Surgery,Shenzhen Sun Yixian Cardiovascular Hospital,Shenzhen,Guangdong 518020,China)

机构地区：[1]深圳市孙逸仙心血管医院心外科,广东深圳518020

出　　处：《岭南心血管病杂志》2018年第4期429-432,共4页South China Journal of Cardiovascular Diseases

基　　金：深圳市科创委2015年课题(项目编号:20150323223951)

摘　　要：目的探讨急性Stanford B型主动脉夹层(type B acute aortic dissection,AADB)腔内修复术的安全性、可行性、有效性,并初步探讨腔内修复治疗时机与预后的关系。方法回顾性分析2015年5月到2017年8月在深圳市孙逸仙心血管医院接受经皮主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)的111例AADB患者的临床资料。患者分为发病至TEVAR时间≤7 d组(G1组50例)、发病至TEVAR时间为7~14 d组(G2组33例)和发病至TEVAR时间>14 d组(G3组28例),比较3组术后院内死亡、并发症发生率、住院时间、住院费用、修复后真假腔血液动力学变化、内脏及下肢动脉供血的改善。结果全部患者均顺利完成TEVAR,无移植物错放及移位、瘤体破裂、中转手术和截瘫等并发症发生。围术期G1组发生脑梗死2例、肾衰竭4例、肢体缺血3例、肠道缺血1例、新破口形成1例;G2组发生肾衰竭3例、短暂性精神异常3例、低氧血症2例、脏器缺血1例、新破口形成1例;G3组发生肾衰竭2例。院内死亡患者2例,其中G1组1例,因术后大量胸腔积液、肾衰竭、多器官功能衰竭死亡;G2组1例,为术后重度低氧血症、肺部真菌感染、多器官功能衰竭死亡;G3组无死亡。术前3组最大真腔直径与最大假腔直径的比值分别为0.46±0.31、0.45±0.21及0.47±0.47,组间比较差异无统计学意义(P>0.05);术后半年最大真腔直径与最大假腔直径比值分别为0.60±0.28、0.65±0.32及0.67±0.38,组间两两比较差异无统计学意义(P>0.05);但各组最大真腔直径与最大假腔直径比值术前、术后比较,差异有统计学意义(P<0.05)。G1组和G2组的住院时间显著少于G3组,差异有统计学意义(P<0.05)。3组住院费用比较,差异无统计学意义(P>0.05)。结论 AADB病情相对稳定的患者2周后进行TEVAR术有利于减少并发症的发生。Objectives To investigate the safety,feasibility and effectiveness of thoracic endovascular aortic repair(TEVAR)in patients with type B acute aortic dissection(AADB),and relationship between the timing of TEVAR and prognosis was also discussed.Methods Clinical data of 111 patients with AADB from May 2015 to August 2017 in Shenzhen Sun Yixian Cardiovascular Hospital were retrospectivly analyzed.All the patients divided into 3 groups according to the duration from onset of symptom to TEVAR:less than 7 days was defined as G1 group(n=50),7-14 days was defined as G2 group(n=33);more than 14 days was defined as G3 group(n=28).In-hospital mortalities,hospital expense,duration of hospital stay,status of aortic reconstruction at half a year after TEVAR were compared among the three groups.Results All the patients were successfully completed TEVAR.No dislocation and displacement of plants,conversion operation,interlayer fracture,paraplegia happened.During perioperative period,there were 2 cases of cerebral infarction,4 cases of renal failure,3 cases of limb ischemia,1 cases of intestinal ischemia,1 case of new break formation in G1 group;there were 1 case of cerebral infarction,1 case of renal failure,1 case of limb ischemia,1 case of new break fomation in G2 group;There were 1 case of cerebral infarction,1 case of renal failure in G3 group.Two patients died during hospitalization:there was 1 case in G1 group,died from multiple organ failure caused by massive pleural effusion and renal failure;there was 1 case in G2 group,died from multiple organ failure caused by severe hypoxemia and pulmonary fungal infection.Ratio of largest true lumen diameter and largest false lumen diameter before treatment in G1 group was 0.46±0.31,in G2 group was 0.45±0.21,and in G3 group was 0.47±0.47,there were no significant differences among the 3 groups(P>0.05).Half a year after TEVAR,ratio of largest true lumen diameter and largest false lumen diameter in G1 group was 0.60±0.28,in G2 group was 0.65±0.32 and in G3 group was 0.67±0.38,the

关 键 词：主动脉夹层 经皮胸主动脉腔内修复术 回顾性分析 

分 类 号：R543.16[医药卫生—心血管疾病]