急性期Stanford B型主动脉夹层患者腔内修复术后主动脉重塑  

Remodeling of aorta after thoracic endovascular aortic repair in patients with acute Stanford type B aortic dissection

作　　者：葛静 刘建平[1] 张永恒[1] 邹坪益 马蓉[1] 唐小娇 严高武 GE Jing;LIU Jianping;ZHANG Yongheng;ZOU Pingyi;MA Rong;TANG Xiaojiao;YAN Gaowu(Department of Cardiovascular Surgery,Suining Municipal Central Hospital,Suining,Sichuan Province 629000,China)

机构地区：[1]遂宁市中心医院心血管外科,四川629000 [2]遂宁市中心医院放射影像科,四川629000 [3]西南医科大学附属医院心血管内科

出　　处：《介入放射学杂志》2021年第11期1113-1118,共6页Journal of Interventional Radiology

基　　金：四川省卫生健康委科研课题项目(17PJ184、19PJ284);遂宁市青年科技人才托举工程科研课题项目(2020)。

摘　　要：目的探讨急性期Stanford B型主动脉夹层(TBAD)胸主动脉腔内修复(TEVAR)术后主动脉重塑及其演变过程。方法回顾性分析2013年6月至2018年6月单中心诊断为急性期TBAD并行TEVAR治疗的217例患者临床和影像学资料。通过RadiAnt Dicom Viewer工作站进行图像后处理,测量主动脉峡部、肺动脉分叉、膈肌、腹腔干、左肾动脉开口及腹主动脉分叉平面的真腔、假腔直径和总直径,记录假腔血栓化程度。结果主动脉峡部、肺动脉分叉平面真腔增大、假腔缩小,差异均有统计学意义(P<0.05),假腔血栓化率高;膈肌、腹腔干、左肾动脉开口平面真腔增大、假腔缩小,真腔增大差异均有统计学意义(P<0.05),假腔缩小差异均无统计学意义(P>0.05),假腔血栓化率较高;腹主动脉分叉平面真腔增大、假腔增大,差异均无统计学意义(P>0.05),假腔血栓化率低。各平面术后总直径较术前无明显变化,差异均无统计学意义(P>0.05)。结论TEVAR术后胸降主动脉段重塑良好,真腔明显扩张,假腔明显缩小、血栓化率高。腹主动脉段重塑不良,可能与远端破口旷置有关。远端假腔直径和总直径变化不显著提示夹层可能稳定,远端破口暂无需手术处理,但严密影像学随访远端破口尚未处理患者十分重要。Objective To discuss the remodeling of aorta after thoracic endovascular aortic repair(TEVAR)in patients with acute Stanford type B aortic dissection and its evolution process.Methods The clinical data and imaging materials of 217 patients with acute Stanford type B aortic dissection,who were treated with TEVAR in a single medical center between June 2013 and June 2018,were retrospectively analyzed.The image post-processing was performed on a RadiAnt Dicom Viewer workstation.The true cavity diameter,false cavity diameter and total aortic diameter at the aortic isthmus plane,pulmonary artery bifurcation plane,diaphragm plane,celiac axis plane,left renal artery origin plane and abdominal aorta bifurcation plane were separately measured.The degree of pseudocavity thrombosis was recorded.Results At the aortic isthmus plane and pulmonary artery bifurcation plane,the true cavity diameter was increased and the false cavity diameter was decreased,the differences were statistically significant(P<0.05),and the degree of pseudocavity thrombosis was higher.At the diaphragm plane,celiac axis plane and left renal artery origin plane,the true cavity diameter was increased and the false cavity diameter was decreased;the differences in true cavity enlargement were statistically significant(P<0.05),while the differences in false cavity reduction were not statistically significant(P>0.05),and the degree of pseudocavity thrombosis was higher.At the abdominal aorta bifurcation plane,both the true lumen and the false lumen were enlarged but the difference between the two was not statistically significant(P>0.05),and the degree of pseudocavity thrombosis was lower.After TEVAR,the total aortic diameters measured on the above mentioned planes showed no obvious changes when compared with the preoperative ones(P>0.05).Conclusion After TEVAR,the descending thoracic aorta segment can obtain favorable remodeling,the true cavity is significantly dilated and the false cavity is significantly reduced.The remodeling of abdominal aortic segment is

关 键 词：主动脉夹层 胸主动脉腔内修复术 主动脉重塑 

分 类 号：R654.3[医药卫生—外科学]