胸主动脉腔内修复术治疗B型主动脉夹层的早中期结果  

Early to mid-term results of thoracic endovascular aortic repair for type B aortic dissection

作　　者：周小彪[1] 林明辉 宋曼[3] 郭宏伟[1] 程刚毅 单忠贵[1] Zhou Xiaobiao;Lin Minghui;Song Man;Guo Hongwei;Cheng Gangyi;Shan Zhonggui(Department of Cardiovascular Surgery,The First Affiliated Hospital of Xiamen University,Fujian Medical University Teaching Hospital,Xiamen 361000,China;Department of Cardiovascular Surgery,School of Medicine,Xiamen University,The First Affiliated Hospital of Xiamen University,Xiamen 361000,China;Department of Radiology,The First Affiliated Hospital of Xiamen University,Fujian Medical University Teaching Hospital,Xiamen 361000,China)

机构地区：[1]厦门大学附属第一医院福建医科大学教学医院心脏外科,厦门361000 [2]厦门大学医学院厦门大学附属第一医院心脏外科,厦门361000 [3]厦门大学附属第一医院福建医科大学教学医院放射科,厦门361000

出　　处：《中华血管外科杂志》2020年第3期175-180,共6页Chinese Journal of Vascular Surgery

摘　　要：目的分析接受不同锚定区胸主动脉腔内修复术(TEVAR)对B型主动脉夹层患者的早中期结果及并发症的影响。方法收集2012年1月至2017年12月厦门大学附属第一医院接受TEVAR治疗的147例B型主动脉夹层患者的临床资料。根据近端破口距左锁骨下动脉开口的距离将患者分为两组:≤2 cm则支架锚定于Zone 2(Zone 2组,40例);>2 cm则支架锚定于Zone 3(Zone 3组,107例)。分析两组患者术后1、3个月及随后每年CTA资料,评估患者的术后并发症发生率(主要是内漏的发生率)和再次干预率。结果Zone 2组年龄低于Zone 3组[(57±9.3)岁比(61±10)岁,t=2.04,P=0.04]。全组患者随访时间(37.8±20.5)个月(范围:6~77个月)。共18例患者TEVAR术后出现并发症,Zone 2组并发症发生率高于Zone 3组,差异有统计学意义[27.5%(11/40)比6.54%(7/107),χ2=11.90,P=0.001];其中10例患者发生内漏,Zone 2组内漏发生率高于Zone 3组,差异有统计学意义[15%(6/40)比3.74%(4/107),χ2=5.82,P=0.025]。共12例患者接受再次干预治疗,Zone 2组再次干预率高于Zone 3组,差异有统计学意义[20%(8/40)比3.74%(4/107),χ2=10.27,P=0.003]。结论与支架锚定于Zone 3的TEVAR比较,支架锚定于Zone 2的TEVAR术后并发症发生率和再次手术干预率更高。Objective To analyze the effects of thoracic endovascular aortic repair(TEVAR)with stents deployed in different landing zones on early to mid-term results in patients with type B aortic dissection.Methods The data of 147 patients with type B aortic dissection receiving TEVAR in the First Affiliated Hospital of Xiamen University from January 2012 to December 2017 were reviewed retrospectively.All of the patients were divided into two groups based on the distance between proximal entry tear and left subclavian artery:(1)≤2 cm,the stent was deployed in Zone 2(Zone 2 group,40 cases);(2)>2 cm,the stent was deployed in Zone 3(Zone 3 group,107 cases).CTA data of the two groups at 1-,3-month and annually thereafter were analyzed to assess the postoperative complication rates(mainly the incidences of endoleak)and reintervention rates.Results The age of the Zone 2 group was younger than that of the Zone 3 group[(57±9.3)years vs(61±10)years,t=2.04,P=0.04].The follow-up period was(37.8±20.5)months(range:6-77 months).In total,there were 18 cases presented with postoperative complications during follow-up,and the complication rate of Zone 2 group was higher than that of Zone 3 group[27.5%(11/40)vs 6.54%(7/107),χ2=11.90,P=0.001].A total of 10 cases appeared with endoleak,and the incidence of endoleak in the Zone 2 group was higher than that in the Zone 3 group[15%(6/40)vs 3.74%(4/107),χ2=5.82,P=0.025].A total of 12 patients were treated with reintervention,and the reintervention rate of Zone 2 group was higher than that of Zone 3 group[20%(8/40)vs 3.74%(4/107),χ2=10.27,P=0.003].Conclusion For type B aortic dissection,stent landing in Zone 2 is associated with higher rates of complications and reintervention than that in Zone 3.

关 键 词：外科手术 内漏 主动脉夹层 支架 

分 类 号：R654.3[医药卫生—外科学]