胸主动脉夹层动脉瘤腔内修复术联合药物治疗稳定型B型主动脉夹层  

Efficacy of thoracic endovascular aortic repair combined with drug in patients with stable type B aortic dissection

作　　者：张冉 陈英[1] 万久贺[1] ZHANG Ran;CHEN Ying;WAN Jiu-he(Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,北京100029

出　　处：《局解手术学杂志》2019年第2期121-124,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：北京市自然科学基金(7182042)

摘　　要：目的对比分析胸主动脉腔内修复术(TEVAR)联合药物与单纯药物治疗对稳定型Standford B型主动脉夹层患者疗效及安全性的影响。方法回顾性分析本院2015年5月至2016年7月收治的142例稳定型Standford B型主动脉夹层患者的临床资料,按照不同治疗方式分为治疗组(n=71)与对照组(n=71)。对照组患者单纯给予药物治疗,治疗组患者在对照组患者基础上联合TEVAR进行治疗,对比分析2组患者的治疗效果及安全性。结果治疗组患者院内死亡率为8. 45%,对照组患者院内死亡率为18. 31%,2组比较差异具有统计学意义(P <0. 05)。治疗组患者术后并发症发生率为12. 68%,对照组患者并未出现主要并发症,2组比较差异具有统计学意义(P <0. 05)。治疗组患者出院30 d内病死率为0,对照组患者出院30 d内病死率为8. 45%,2组比较差异具有统计学意义(P <0. 05)。术后随访6个月、1年、2年的生存率,治疗组分别为94. 37%、85. 92%、77. 46%,对照组分别为91. 55%、83. 10%、71. 83%,2组比较差异无统计学意义(χ2=0. 351,P=0. 172)。结论 TEVAR联合药物治疗稳定型Standford B型主动脉夹层具有良好的近、中期疗效,但术后相关并发症发生率较高,影响预后生存率,应严格把握手术适应证,选择良好手术时机,谨慎术中操作。Objective To compare the effects and safety of thoracic endovascular aortic repair(TEVAR)combined with drug and drug alone in patients with stable type B aortic dissection.Methods The clinical data of 142 patients with stable Standford type B aortic dissection admitted into our hospital from May 2015 to July 2016 were retrospectively analyzed,who were divided into treatment group(n=71)and control group(n=71)according to different treatment methods.The patients in the control group were treated with drugs alone.The patients in the treatment group were treated with TEVAR on the basis of the control group.The therapeutic effects and safety between the two groups were compared.Results The in-hospital mortality rate was 8.45%in the treatment group and 18.31%in the control group,there was a significant difference in the in-hospital mortality between the two groups(P<0.05).The incidence of postoperative complications in the treatment group was 12.68%.There was no major complications in the control group.There was a significant difference in the incidence of nosocomial complications between the two groups(P<0.05).The mortality of the patients in the treatment group was 0 within 30 days after discharge,and that of the control group was 8.45%,the difference was significant(P<0.05).The survival rates of the treatment group after 6 months,1 year and 2 years were 94.37%,85.92%and 77.46%,respectively;the control group were 91.55%,83.10%and 71.83%,respectively,the differences were significant(χ^2=0.351,P=0.172).Conclusion TEVAR combined with drug therapy for stable Standford type B aortic dissection has good short-and medium-term results,but the incidence of postoperative complications is high,which affects the prognosis survival rate.Therefore,in the course of clinical treatment,surgical indications should be strictly controlled,good surgical timing should be selected,and intraoperative operation should be carefully performed to reduce the incidence of postoperative complications and improve the prognosis survival rate.

关 键 词：腔内修复术 稳定型StandfordB型 主动脉夹层 疗效 安全性 胸主动脉 动脉瘤 

分 类 号：R543.1[医药卫生—心血管疾病]