腔内修复术治疗非复杂性急性Stanford B型主动脉夹层单中心近中期结果  

Thoracic endovascular aortic repair for uncomplicated acute type B aortic dissection

作　　者：林明辉 郭宏伟[2] 周小彪[2] 宋曼[3] 程刚毅 单忠贵[2] Lin Minghui;Guo Hongwei;Zhou Xiaobiao;Song Man;Cheng Gangyi;Shan Zhonggui(Graduate School,School of medicine,Xiamen University,Xiamen 361000,China;Department of Cardiovascular surgery,The First Affiliated Hospital of Xiamen University,Fujian Medical University Teaching Hospital,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]厦门大学医学院研究生院,厦门361000 [2]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 [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》2021年第2期88-92,共5页Chinese Journal of Vascular Surgery

摘　　要：目的评价胸主动脉腔内修复术(TEVAR)与单纯药物治疗非复杂性急性Stanford B型主动脉夹层(ATBAD)的近中期效果。方法回顾性分析2012年1月至2018年12月厦门大学附属第一医院收治的203例非复杂性ATBAD患者的临床资料,其中男性118例,女性85例;年龄(60.3±10.2)岁。根据治疗方式分为药物治疗组(药物组,67例)和腔内修复术治疗组(TEVAR组,136例)。分析两组患者手术资料和随访资料,评估患者的术后并发症发生率和再次干预率。结果203例患者随访时间为(3.7±1.8)年(范围:3~84个月)。随访期间总并发症发生率为15.3%(31/203),再干预率为10.3%(21/203),死亡率为6.4%(13/203)。TEVAR组主动脉相关并发症发生率(26.9%比9.6%;P<0.05)、再干预率(19.4%比6.6%;P<0.05)、死亡率(13.4%比2.9%;P<0.05)均低于药物组,差异有统计学意义。与药物组相比,TEVAR组主动脉夹层破裂(7.5%比1.5%;P<0.05)、逆撕A型夹层(4.5%比1.5%;P>0.05)均未显示出更高的发生率。结论TEVAR治疗非复杂性ATBAD安全、有效。与单纯药物治疗相比,非复杂性ATBAD患者接受TEVAR治疗显示出更好的近中期效果。Objective To compare the early and mid-term results of thoracic endovascular aortic repair(TEVAR)with covered stent and simple medication in treating uncomplicated acute type B aortic dissection(ATBAD).Methods The clinical data of 203 patients(118 males and 85 females)with uncomplicated ATBAD admitted to the First Affiliated Hospital of Xiamen University from January 2012 to December 2018 were collected and analyzed.The patients were divided into two groups based on the ways of treatment:simple medication group(Med group,67 cases)and TEVAR group(136 cases).The operative and follow-up data of the patients in two groups were analyzed to evaluate the incidence rate of postoperative complications and the reintervention rate.Results The follow-up time was(3.7±1.8)years(range:3-84 months).During the follow-up period,the overall incidence rate of complications was 15.3%(31/203),the reintervention rate was 10.3%(21/203),and the mortality rate was 6.4%(13/203).The incidence rate of aortic-related complications(26.9%vs.9.6%;P<0.05),the reintervention rate(19.4%vs.6.6%;P<0.05),and the mortality rate(13.4%vs.2.9%;P<0.05)in the TEVAR group were significantly lower than those in the Med group,and the differences were statistically significant.Compared with the Med group,the TEVAR group did not show a higher incidence of aortic dissection rupture(7.5%vs.1.5%;P<0.05)and retrograde type A aortic dissection(4.5%vs.1.5%;P>0.05).Conclusion For the treatment of uncomplicated ATBAD,TEVAR is effective and safe.Compared with simple medication,TEVAR can achieve better early and mid-term results in treating uncomplicated ATBAD.

关 键 词：腔内修复术 并发症 主动脉夹层 Stanford B型 支架 

分 类 号：R654.3[医药卫生—外科学]