主动脉腔内修复术在复杂B型夹层患者中应用的围术期效果及长期生存率分析  

Analysis of perioperative effects and long-term survival rate of thoracic endovascular aortic repair in patients with complicated type B dissection

作　　者：郑军[1] 任长伟[1] 阳晟[1] 李建荣[1] 许尚栋[1] 孙立忠[1] 高慧强[1] ZHENG Jun;REN Changwei;YANG Sheng;LI Jiangrong;XU Shangdong;SUN Lizhong;GAO Huiqiang(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

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

出　　处：《心肺血管病杂志》2019年第9期938-941,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析主动脉腔内修复术(TEVAR)在复杂B型夹层患者中应用的围术期效果与长期生存状况。方法:收集自2001年6月至2015年3月,在我院大血管中心行TEVAR治疗的复杂B型夹层患者的基本资料、围术期资料并进行随访。将所得的数据进行分析。结果:共有179例患者诊断为复杂B型夹层并接受TEVAR治疗,其中男性162例(90.5%),女性17例(9.5%),平均年龄(51.3±11.6)岁。围术期死亡7例,病死率3.9%,术后肢体缺血4例(2.2%),胃肠缺血3例(1.7%),肾衰竭3例(1.7%),左上肢动脉急性血栓形成1例(0.6%),股动脉穿刺口局限性夹层形成1例(0.6%),逆行性A型夹层形成1例(0.6%)。无围术期脑梗死、截瘫发生。TEVAR术后5年,10年生存率分别为95.8%,82.1%,5年,10年再次干预率分别为3.7%,5.4%。结论:本研究呈现了TEVAR在复杂B型夹层患者中应用的围术期并发症及5年,10年生存与再干预情况。术后仍持续存在的灌注不良是患者死亡的主要原因,围术期应及时识别灌注不良的症状并及时恢复灌注以减少并发症和术后死亡的发生。Objective: To analyze perioperative outcomes and long-term survival of thoracic endovascular aortic repair(TEVAR) in patients with complicated type B dissection. Methods: Demographic, perioperative, and follow-up data of patients with complicated type B dissection treated with TEVAR in our hospital from June 2001 to March 2015 were collected and analyzed. Results: A total of 179 patients were diagnosed with complicated type B dissection and underwent TEVAR, including 162 males(90.5%) and 17 females(9.5%) with an average age of(51.3±11.6) years. Perioperative death occurred in seven cases for a mortality rate of 3.9%, postoperative limb ischemia in four cases(2.2%), gastrointestinal ischemia in three cases(1.7%), renal failure in three cases(1.7%), left upper extremity arterial acute thrombosis in one case(0.6%), retrograde type A dissection in one case(0.6%) and localized dissection of the femoral artery puncture site in one case(0.6%). There was no perioperative cerebral infarction or paraplegia. The 5-and 10-year survival rates were 95.8% and 82.1%, respectively, and the 5-and 10-year reintervention rates were 3.7% and 5.4%, respectively. Conclusions: This study presents rates of perioperative complications as well as 5-and 10-year survival and reintervention rates of TEVAR in patients with complicated type B dissection. Malperfusion, which persists after surgery, is the leading cause of death. Malperfusion symptoms should be identified and reperfusion resumed in time to reduce complications.

关 键 词：复杂B型夹层 生存率 主动脉腔内修复术 

分 类 号：R54[医药卫生—心血管疾病]