腔内治疗3级钝性外伤后胸主动脉扩张性疾病的中期随访结果  

Mid-term follow-up results of endovascular repair for Grade 3 blunt thoracic aortic injuries

作　　者：李旭 张婉 丁勇 周旻 史振宇 LI Xu;ZHANG Wan;DING Yong;ZHOU Min;SHI Zhen-yu(Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China;Department of Vascular Surgery, Huadong Hospital, Fudan University, Shanghai 200040, China)

机构地区：[1]复旦大学附属中山医院血管外科,上海200032 [2]复旦大学附属华东医院血管外科,上海200040

出　　处：《中国临床医学》2021年第2期204-209,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81870342).

摘　　要：目的:探讨采用胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)治疗胸主动脉钝性创伤(blunt thoracic aortic injurie,BTAI)的中期随访结果,并基于断层扫描血管造影(computed tomography angiography,CTA)结果分析术后主动脉扩张情况。方法:选取2008年7月至2015年6月复旦大学附属中山医院收治的BTAI患者28例。根据BTAIs分级,钝性外伤后胸主动脉瘤及胸主动脉夹层归为3级,中位随访时间51.5个月。研究终点为生存、再干预、支架移植物相关并发症发生或TEVAR术后主动脉重构及扩张。术后在主动脉的不同层面测量主动脉最大径,并与术前进行对比。结果:28例患者中,25例为钝性外伤后胸主动脉瘤,3例为钝性外伤后胸主动脉夹层。男性19例,女性9例。平均年龄(47.0±13.7)岁。患者从受伤到接受TEVAR治疗的中位时间为8 d,技术成功率为100%(28/28),临床成功率为96.4%(27/28)。1例患者在接受TEVAR 1周后死于肺栓塞,余27例均纳入随访且随访期间无死亡。随访期间,未发生卒中、内漏等并发症,CTA发现鸟嘴综合征12例、左锁骨下动脉狭窄或闭塞4例,但不须再干预,所有患者主动脉重构良好。在肺动脉分叉处升主动脉、肺动脉分叉处降主动脉和主动脉分叉处,观察到主动脉扩张,但差异无统计学意义,且扩张程度与并发症无关。结论:TEVAR对BTAI所致胸主动脉假性动脉瘤及主动脉夹层安全有效。Objective:To explore the mid-term follow-up results of thoracic endovascular aortic repair(TEVAR)for Grade 3 blunt thoracic aortic injuries(BTAI),and analyze the postoperative aortic dilatation based on the imaging of computed tomographic angiography(CTA).Methods:A total of 28 consecutive Grade 3 BTAI in patients treated with TEVAR in Zhongshan Hospital,Fudan University between July 2008 and June 2015.Trauma-related pseudoaneurysms and dissections were categorized into Grade 3 BTAI,mean follow-up time was 5.5 months.Endpoints were survival,reintervention,stent graft(SG)-related complications,and postoperative aortic remodeling and dilatation.The pre-operative and post-operative aorta diameters of different aspects were also recorded and compared.Results:Among 28 patients,25 pseudoaneurysms and 3 dissections were recruited.There were 19 males and 9 females,the average age was(47.0±13.7)years old.All patients underwent delayed TEVAR with a median of 8 days after trauma.One patient died of pulmonary embolism 1 week after TEVAR.The technical success rate of TEVAR was 100.0%(28/28)and clinical success rate was 96.4%(27/28).Twenty-seven patients survived and were followed up.During this period,no stroke or endoleak occurred.No reintervention was performed although 14 SG-related complications(including 12 bird-beak configurations and 4 stenotic or occluded LSA)were observed.Aortic dilation was observed in ascending aorta at the bifurcation of pulmonary artery,descending aorta at the bifurcation of pulmonary artery,aortic bifurcation,but there was no significant difference between pre-operation and post-operation.Moreover,there was no correlation between aortic dilation and complications.Conclusions:TEVAR is safe and effective for thoracic aortic pseudoaneurysm and aortic dissection induced by BTAI.

关 键 词：胸主动脉钝性创伤 胸主动脉腔内修复术 主动脉夹层 

分 类 号：R543.1+5[医药卫生—心血管疾病]